25145522
BACKGROUND	The 2014 Eighth Joint National Committee panel recommendations for management of high blood pressure ( BP ) recommend a systolic BP threshold for initiation of drug therapy and a therapeutic target of < 150 mm Hg in those60 years of age , a departure from prior recommendations of < 140 mm Hg .
BACKGROUND	However , it is not known whether this is an optimal choice , especially for the large population with coronary artery disease ( CAD ) .
OBJECTIVE	This study sought to evaluate optimal BP in patients60 years of age .
METHODS	Patients 60 years of age or older with CAD and baseline systolic BP > 150 mm Hg randomized to a treatment strategy on the basis of either atenolol/hydrochlorothiazide or verapamil-SR ( sustained release ) / trandolapril in INVEST ( INternational VErapamil SR Trandolapril STudy ) were categorized into 3 groups on the basis of achieved on-treatment systolic BP : group 1 , < 140 mm Hg ; group 2 , 140 to < 150 mm Hg ; and group 3,150 mm Hg .
METHODS	Primary outcome was first occurrence of all-cause death , nonfatal myocardial infarction ( MI ) , or nonfatal stroke .
METHODS	Secondary outcomes were all-cause mortality , cardiovascular mortality , total MI , nonfatal MI , total stroke , nonfatal stroke , heart failure , or revascularization , tabulated separately .
METHODS	Outcomes for each group were compared in unadjusted and multiple propensity score-adjusted models .
RESULTS	Among 8,354 patients included in this analysis with an accumulated 22,308 patient-years of follow-up , 4,787 ( 57 % ) achieved systolic BP of < 140 mm Hg ( group 1 ) , 1,747 ( 21 % ) achieved systolic BP of 140 to < 150 mm Hg ( group 2 ) , and 1,820 ( 22 % ) achieved systolic BP of150 mm Hg ( group 3 ) .
RESULTS	In unadjusted models , group 1 had the lowest rates of the primary outcome ( 9.36 % vs. 12.71 % vs. 21.32 % ; p < 0.0001 ) , all-cause mortality ( 7.92 % vs. 10.07 % vs. 16.81 % ; p < 0.0001 ) , cardiovascular mortality ( 3.26 % vs. 4.58 % vs. 7.80 % ; p < 0.0001 ) , MI ( 1.07 % vs. 1.03 % vs. 2.91 % ; p < 0.0001 ) , total stroke ( 1.19 % vs. 2.63 % vs. 3.85 % ; p < 0.0001 ) , and nonfatal stroke ( 0.86 % vs 1.89 % vs 2.86 % ; p < 0.0001 ) compared with groups 2 and 3 , respectively .
RESULTS	In multiple propensity score-adjusted models , compared with the reference group of < 140 mm Hg ( group 1 ) , the risk of cardiovascular mortality ( adjusted hazard ratio [ HR ] : 1.34 ; 95 % confidence interval [ CI ] : 1.01 to 1.77 ; p = 0.04 ) , total stroke ( adjusted HR : 1.89 ; 95 % CI : 1.26 to 2.82 ; p = 0.002 ) and nonfatal stroke ( adjusted HR : 1.70 ; 95 % CI : 1.06 to 2.72 ; p = 0.03 ) was increased in the group with BP of 140 to < 150 mm Hg , whereas the risk of primary outcome , all-cause mortality , cardiovascular mortality , total MI , nonfatal MI , total stroke , and nonfatal stroke was increased in the group with BP150 mm Hg .
CONCLUSIONS	In hypertensive patients with CAD who are60 years of age , achieving a BP target of 140 to < 150mm Hg as recommended by the JNC-8 panel was associated with less benefit than the previously recommended target of < 140 mm Hg .

