Jackson T. Wright, Jr., MD, PhD; Lawrence J. Fine, MD, DrPH; Daniel T. Lackland, DrPH; Gbenga Ogedegbe, MD, MPH, MS; Cheryl R. Dennison Himmelfarb, PhD, RN, ANP
Disclaimer: The views expressed in this paper are those of the authors and do not necessarily reflect the view of the National Heart, Lung, and Blood Institute or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Dr. Michael Mussolino, National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Epidemiology Branch, for his analysis of the U.S. mortality data.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2981.
Requests for Single Reprints: Jackson T. Wright Jr., MD, PhD, University Hospitals Case Medical Center, Bolwell Suite 2200, 11100 Euclid Avenue, Cleveland, OH 44106-6053; e-mail, Jackson.Wright@case.edu.
Current Author Addresses: Dr. Wright: Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Bolwell Suite 2200, 11100 Euclid Avenue, Cleveland, OH 44106-6053.
Dr. Fine: Division of Cardiovascular Sciences, Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Two Rockledge Centre, Room 10216, 6701 Rockledge Drive, MSC 7936, Bethesda, MD 20892-7936.
Dr. Lackland: Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425.
Dr. Ogedegbe: Center for Healthful Behavior Change, New York University School of Medicine, Translational Research Building, 227 East 30th Street, Room 633, New York, NY 10010.
Dr. Dennison Himmelfarb: Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205.
Author Contributions: Conception and design: J.T. Wright, L.J. Fine, D.T. Lackland, G. Ogedegbe, C.R. Dennison Himmelfarb.
Analysis and interpretation of the data: J.T. Wright, L.J. Fine, D.T. Lackland, C.R. Dennison Himmelfarb.
Drafting of the article: J.T. Wright, L.J. Fine, D.T. Lackland, G. Ogedegbe.
Critical revision of the article for important intellectual content: J.T. Wright, L.J. Fine, D.T. Lackland, G. Ogedegbe, C.R. Dennison Himmelfarb.
Final approval of the article: J.T. Wright, L.J. Fine, D.T. Lackland, G. Ogedegbe, C.R. Dennison Himmelfarb.
Administrative, technical, or logistic support: J.T. Wright, C.R. Dennison Himmelfarb.
Collection and assembly of data: J.T. Wright, L.J. Fine, C.R. Dennison Himmelfarb.
Table 1. U.S. Cardiovascular Disease Death Rates for Persons Younger and Older Than 65 y
Smoothed weighted frequency distribution, median, and 90th percentile of systolic blood pressure for persons aged 60 to 74 y: United States, 1959–2010.
Reproduced from Lackland and colleagues (4). NHANES = National Health and Nutrition Examination Survey; NHES = National Health Examination Survey.
Table 2. Trials Comparing Different Systolic Blood Pressure Thresholds
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Zrinko Petrak, MD
April 30, 2014
In their recent article published in the April 1, 2014 issue of the Annals of Internal Medicine, entitled "EVIDENCE SUPPORTING A SYSTOLIC PRESSURE GOAL OF LESS THAN 150 MMHG IN PATIENTS AGED 60 YEARS OR OLDER: THE MINORITY VIEW", Wright and colleagues disagree with the 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults recommendation to increase the target systolic blood pressure (SBP) from 140 to 150 mmHg in persons aged 60 years or older, without diabetes mellitus or chronic kidney disease. However, lowering elevated SBP to less than 140 mmHg in some elderly patients with wide pulse pressures (PP) , may lead to a compromise of their vital organs perfusion pressures, by decreasing their mean arterial pressure (MAP) to less than the generally recommended value of 70-110 mmHG.
Example: 75-year-old patient with BP of 143/18 mmHg
PP: (systolic BP - Diastolic BP) = 125 mmHg
MAP: [ (2X diastolic BP) + SBP/3 ] = 59.6 mmHg
Also, when the systolic hypertension is accompanied by severe aortic stenosis, maintaing the systolic BP above 140 mmHg may be necessary in some cases, in order to overcome very high trans valvular aortic valve gradient that may be present in some of these patients.
Zrinko Petrak, M.D.
Wright JT, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR. Evidence Supporting a Systolic Blood Pressure Goal of Less Than 150 mm Hg in Patients Aged 60 Years or Older: The Minority View. Ann Intern Med. 2014;160:499-503. doi: 10.7326/M13-2981
Download citation file:
Published: Ann Intern Med. 2014;160(7):499-503.
Cardiology, Coronary Risk Factors, Hypertension, Nephrology.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only