Relationship of Blood Pressure With Mortality and Cardiovascular Events Among Hypertensive Patients aged ≥60 years in Rural Areas of China: A Strobe-Compliant Study

The Eighth Joint National Committee (JNC-8) panel recently recommended a systolic blood pressure (BP) threshold of ≥150 mmHg for the initiation of drug therapy and a therapeutic target of <150/90 mmHg in patients ≥60 years of age. However, results from some post-hoc analysis of randomized controlled trials and observational studies did not support these recommendations. In the prospective cohort study, 5006 eligible hypertensive patients aged ≥60 years from rural areas of China were enrolled for the present analysis. The association between the average follow-up BP and outcomes (all-cause and cardiovascular death, incident coronary heart disease [CHD], and stroke), followed by a median of 4.8 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. The relationship between BP (systolic or diastolic) showed an increased or J-shaped curve association with adverse outcomes. Compared with the reference group of BP <140/90 mmHg, the risk of all-cause death (hazard ratio [HR]: 2.698; 95% confidence interval [CI]: 1.989–3.659), cardiovascular death (HR: 2.702; 95% CI: 1.855–3.935), incident CHD (HR: 3.263; 95% CI: 2.063–5.161), and stroke (HR: 2.334; 95% CI: 1.559–3.945) was still significantly increased in the group with BP of 140–149/<90 mmHg. Older hypertensive patients with BP of 140–149/<90 mmHg were at higher risk of developing adverse outcomes, implying that lenient BP control of 140–149/<90 mmHg, based on the JNC-8 guidelines, may not be appropriate for hypertensive patients aged ≥60 years in rural areas of China.