Supplemental Material
Supplemental Table 1. Definition of blood pressure categories
Supplemental Table 2. Multivariable-adjusted association of blood pressure category with CVD stratified by age
Supplemental Table 3. Incidence of cardiovascular disease by diabetes status
Supplemental Table 4. Association of blood pressure category with CVD additionally adjusted for pack years smoking
Supplemental Table 5. Association of blood pressure category with CVD in FHS additionally adjusted for pack years smoking, lipid treatment, left ventricular hypertrophy, and microalbuminuria
Supplemental Figure 1. Association of blood pressure category with CVD adjusted for age as a continuous variable
Supplemental Table 1. Definition of blood pressure categories
BP indicates blood pressure
BP Category Systolic BP Diastolic BP <90 mm Hg? Taking BP meds?
1. No hypertension by JNC 7 or JNC 8 <140 mm Hg Yes No
2. Needs BP meds by JNC 7, no meds by JNC 8 140-149 mm Hg Yes No
3. Successfully treated by JNC 7, unnecessarily treated by JNC 8
<140 mm Hg Yes Yes
4. Inadequately treated by JNC 7, successfully treated by JNC 8
140-149 mm Hg Yes Yes
5. Hypertension by JNC 7 and JNC 8 ≥150 mm Hg (with diastolic BP <90 mm Hg)
or any (with diastolic BP
≥90 mm Hg)
No Yes or No
Supplemental Table 2. Multivariable-adjusted association of blood pressure category with CVD stratified by age
HR represents hazards ratio for each group compared with the referent.
Multivariable model is adjusted for sex, total/HDL cholesterol, diabetes status, and current smoking.
A Bonferroni adjustment was used when calculating p-values and confidence intervals to account for multiple comparisons.
Framingham Heart Study
Blood pressure category Age <60 years
HR (95% CI) p value Age ≥60 years
HR (95% CI) p value
1. No hypertension by JNC 7 or JNC 8 Referent -- Referent --
2. Needs BP meds by JNC 7, no meds by JNC 8 2.25 (1.37, 3.71) 0.0002 1.28 (0.79, 2.09) 0.81 3. Successfully treated by JNC 7, unnecessarily
treated by JNC 8 2.84 (1.95, 4.13) <0.0001 1.45 (0.99, 2.14) 0.06
4. Inadequately treated by JNC 7, successfully
treated by JNC 8 3.51 (1.57, 7.82) 0.0004 2.74 (1.77, 4.26) <0.0001
5. Hypertension by JNC 7 and JNC 8 2.79 (2.21, 3.51) <0.0001 1.57 (1.14, 2.16) 0.0016 Jackson Heart Study
Blood pressure category Age <60 years
HR (95% CI) p value Age ≥60 years
HR (95% CI) p value
1. No hypertension by JNC 7 or JNC 8 Referent -- Referent --
2. Needs BP meds by JNC 7, no meds by JNC 8 3.85 (0.54, 27.33) 0.09 2.25 (0.86, 2.16) 0.16 3. Successfully treated by JNC 7, unnecessarily
treated by JNC 8 3.22 (1.30, 8.02) 0.0013 2.21 (1.04, 4.70) 0.0083
4. Inadequately treated by JNC 7, successfully
treated by JNC 8 3.00 (0.66, 13.63) 0.07 2.01 (0.74, 5.47) 0.08
5. Hypertension by JNC 7 and JNC 8 4.83 (1.93, 12.04) <0.0001 2.15 (0.94, 4.89) 0.02
Supplemental Table 3. Incidence of cardiovascular disease by diabetes status
Framingham Heart Study
No diabetes Diabetes
Blood pressure category
Crude incidence rate (n events/ n at
risk)
Multivariable- adjusted*
HR (95% CI)
p value Crude incidence rate (n events/ n at
risk)
Multivariable- adjusted*
HR (95% CI)
p value
1. No hypertension by JNC 7 or JNC 8
5.0 (452/8039) Referent - 24.3 (37/150) Referent -
2. Needs BP meds by JNC 7, no meds by JNC 8
12.4 (47/363) 1.76 (1.18, 2.60) 0.0015 47.4 (11/27) 2.03 (0.88, 4.71) 0.14 3. Successfully treated by JNC 7,
unnecessarily treated by JNC 8
16.0 (100/604) 2.32 (1.72, 3.13) <0.0001 32.8 (27/88) 1.44 (0.76, 2.72) 0.60 4. Inadequately treated by JNC 7,
successfully treated by JNC 8 36.9 (51/154) 4.30 (2.88, 6.43) <0.0001 35.7 (10/32) 1.36 (0.55, 3.36) 1.00 5. Hypertension by JNC 7 and
JNC 8
15.0 (259/1639) 2.41 (1.96, 2.97) <0.0001 41.8 (53/141) 1.57 (0.91, 2.70) 0.16
Jackson Heart Study
No diabetes Diabetes
Blood pressure category
Crude incidence rate (n events/ n at
risk)
Multivariable- adjusted HR (95% CI)
p value Crude incidence rate (n events/ n at
risk)
Multivariable- adjusted HR (95% CI)
p value
1. No hypertension by JNC 7 or JNC 8
1.8 (14/870) Referent - 11.8 (9/86) Referent -
2. Needs BP meds by JNC 7, no
meds by JNC 8 8.1 (3/41) 1.68 (0.53, 13.01) 0.13 38.4 (3/9) 2.94 (0.55, 15.67) 0.11
3. Successfully treated by JNC 7, unnecessarily treated by JNC 8
8.0 (61/843) 3.58 (1.69, 7.62) <0.0001 20.5 (60/338) 1.78 (0.72, 4.37) 0.11 4. Inadequately treated by JNC 7,
successfully treated by JNC 8
5.6 (5/96) 1.86 (0.50, 6.97) 0.24 30.0 (11/44) 2.51 (0.81, 7.77) 0.04 5. Hypertension by JNC 7 and
JNC 8 8.8 (39/505) 3.96 (1.81, 8.68) <0.0001 25.8 (25/116) 2.17 (0.82, 5.74) 0.05
HR represents hazards ratio for each group compared with the referent.
*Multivariable model is adjusted for age (<60 years versus ≥60 years), sex, total/HDL cholesterol, and current smoking.
A Bonferroni adjustment was used when calculating p-values and confidence intervals to account for multiple comparisons.
Supplemental Table 4. Association of blood pressure category with CVD additionally adjusted for pack years smoking
HR represents hazards ratio for each group compared with the referent.
Multivariable model is adjusted for age <60 versus ≥60 years, sex, total/HDL cholesterol, diabetes status, current smoking, and pack years smoking.
A Bonferroni adjustment was used when calculating p-values and confidence intervals to account for multiple comparisons.
Framingham Heart Study (N=10,858)
Blood pressure category HR (95% CI) p value
1. No hypertension by JNC 7 or JNC 8 Referent --
2. Needs BP meds by JNC 7, no meds by JNC 8 1.92 (1.34, 2.75) <0.0001
3. Successfully treated by JNC 7, unnecessarily treated by JNC 8 2.16 (1.62, 2.87) <0.0001 4. Inadequately treated by JNC 7, successfully treated by JNC 8 3.64 (2.44, 5.44) <0.0001
5. Hypertension by JNC 7 and JNC 8 2.29 (1.88, 2.81) <0.0001
Jackson Heart Study (N=2,945)
Blood pressure category HR (95% CI) p value
1. No hypertension by JNC 7 or JNC 8 Referent --
2. Needs BP meds by JNC 7, no meds by JNC 8 3.04 (0.96, 9.65) 0.0157
3. Successfully treated by JNC 7, unnecessarily treated by JNC 8 2.87 (1.60, 5.13) <0.0001 4. Inadequately treated by JNC 7, successfully treated by JNC 8 2.70 (1.83, 6.17) 0.0027
5. Hypertension by JNC 7 and JNC 8 3.29 (1.78, 6.07) <0.0001
Supplemental Table 5. Association of blood pressure category with CVD in FHS additionally adjusted for pack years smoking, lipid treatment, left ventricular hypertrophy, and microalbuminuria
HR represents hazards ratio for each group compared with the referent.
Multivariable model is adjusted for age <60 versus ≥60 years, sex, total/HDL cholesterol, diabetes status, current smoking, pack years smoking, left ventricular hypertrophy, lipid lowering treatment, and urine albumin >30 mg/gm of creatinine.
A Bonferroni adjustment was used when calculating p-values and confidence intervals to account for multiple comparisons.
Blood pressure category HR (95% CI) p value
1. No hypertension by JNC 7 or JNC 8 Referent --
2. Needs BP meds by JNC 7, no meds by JNC 8 1.93 (1.34, 2.79) <0.0001
3. Successfully treated by JNC 7, unnecessarily treated by JNC 8 2.09 (1.56, 2.80) <0.0001 4. Inadequately treated by JNC 7, successfully treated by JNC 8 3.30 (2.16, 5.02) <0.0001
5. Hypertension by JNC 7 and JNC 8 2.23 (1.81, 2.76) <0.0001