The JNC 8 Recommendations for BP Treatment May Not be Appropriate in an Older Person
Mr. RG is a 69-year-old asymptomatic black postal worker who walks four miles each day. He stopped smoking cigarettes one year ago. Because his fasting serum lipids six months ago showed a serum total cholesterol of 260 mg/dL, a serum low-density lipoprotein (LDL) cholesterol of 192 mg/dL, a serum high-density lipoprotein (HDL) cholesterol of 40 mg/dL, and serum triglycerides of 140 mg/dL, his physician prescribed rosuvastatin 40 mg daily as recommended by 2013 American College of Cardiology (ACC)/American Heart Association (AHA) lipid guidelines.1
His other laboratory data were normal, including a serum potassium of 4.5 meq/L, a fasting blood sugar of 86 mg/dL, and a serum creatinine of 1.0 mg/dL. His physical examination at that time was normal except for a blood pressure of 148/88 mm Hg and a left ventricular fourth heart sound. His body mass index was 24.5 kg/ m2. He was not on any medication that could cause hypertension. His father had died at age 54 years of a stroke associated with hypertension. His mother had died at age 62 years of a stroke associated with hypertension. A 12-lead electrocardiogram showed sinus rhythm and left ventricular hypertrophy. His physician did not prescribe antihypertensive medication consistent with recommendations in the 2013 Eighth Joint National Committee (JNC 8) guidelines.2
At this visit, his blood pressure was 148/88 mm Hg. His laboratory data were normal including a fasting serum total cholesterol of 166 mg/dL, a serum LDL cholesterol of 98 mg/dL, a serum HDL cholesterol of 44 mg/dL, and serum triglycerides of 120 mg/dL. A two-dimensional echocardiogram showed concentric left ventricular hypertrophy with a left ventricular mass index of 160 grams/m2.
Would this patient benefit from being treated with antihypertensive medication?