Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study

Vidal‐Petiot, Emmanuelle; Ford, Ian; Greenlaw, Nicola; Ferrari, Roberto; Fox, Kim; Tardif, Jean‐Claude; Tendera, Michał; Tavazzi, Luigi; Bhatt, Deepak L.; Steg, Philippe Gabriel

doi:10.1016/s0140-6736(16)31326-5

Cited by 379 publications

(231 citation statements)

References 31 publications

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“…Individuals with known CAD and hypertension enrolled in the international verapamil-trandolapril study (INVEST) study and CLARIFY registries had increased risk of cardiovascular events and mortality when DBP < 60 mmHg. 3,22,23 In the current study, CAC > 0 among persons without known clinical CAD identified individuals at higher relative risk of CHD events and all-cause mortality when DBP < 60 mmHg. There was no association between low DBP and events among those without calcified coronary atherosclerosis; however, due to the moderate sample size we cannot rule out that these individuals may also be at risk (albeit of lower magnitude) from low DBP.…”

Section: Discussionmentioning

confidence: 51%

“…2–6 Recent data from the CLARIFY (Prospective observational longitudinal registry of patients with stable coronary artery disease) cohort suggest that this association is particularly strong among individuals with known coronary artery disease (CAD). 3 Presumably coronary perfusion distal to vessels with stenosis is impaired further by low DBP. While the association between low DBP and cardiac events is well established among adults with known clinical CAD, 6 little is known about the far larger demographic of persons with subclinical CAD (i.e., atherosclerotic coronary disease without prior clinical diagnosis).…”

Section: Introductionmentioning

confidence: 99%

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Relation of Diastolic Blood Pressure and Coronary Artery Calcium to Coronary Events and Outcomes (From the Multi-Ethnic Study of Atherosclerosis)

Rahman

Rifai

Blaha

et al. 2017

The American Journal of Cardiology

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Diastolic blood pressure has a J-curve relationship with coronary heart disease and death. Because this association is thought to reflect reduced coronary perfusion at low diastolic blood pressure, we hypothesized that the J-curve would be most pronounced among persons with coronary artery calcium. Among 6,811 participants from the Multi-Ethnic Study of Atherosclerosis, we used Cox models to examine if diastolic blood pressure category is associated with coronary heart disease events, stroke, and mortality. Analyses were conducted in the sample overall and after stratification by coronary artery calcium score. In multivariable-adjusted analyses, compared with diastolic blood pressure of 80 to 89 mmHg (reference), persons with diastolic blood pressure <60 mmHg had increased risk of coronary heart disease events (hazard ratio 1.69 [95% confidence interval 1.02–2.79]) and all-cause mortality (hazard ratio 1.48 [95% confidence interval 1.10–2.00]), but not stroke. After stratification, associations of diastolic blood pressure <60 mmHg with events were present only among participants with coronary artery calcium >0. Diastolic blood pressure <60 mmHg was not associated with events when coronary artery calcium was zero. However, the association between diastolic blood pressure and events did not demonstrate statistical interaction when stratified by presence or absence of coronary calcium. We also found no interaction in the association between low diastolic blood pressure and events based on race. In conclusion, diastolic blood pressure <60 mmHg was associated with increased risk of coronary heart disease events and all-cause mortality in the sample overall, but this association appeared strongest among individuals with subclinical atherosclerosis.

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Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Relation of Diastolic Blood Pressure and Coronary Artery Calcium to Coronary Events and Outcomes (From the Multi-Ethnic Study of Atherosclerosis)

Rahman

Rifai

Blaha

et al. 2017

The American Journal of Cardiology

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“…On the other hand, intensive blood pressure control did improve outcomes among patients with type 2 diabetes in the ACCORD trial and in those with stroke, a nadir SBP of 120–128 mm Hg was associated with lower risk of adverse events(18, 22). We did not find effect modification of the observed associations by diabetes.…”

Section: Discussionmentioning

confidence: 95%

“…For instance, in a study that used registry clinical practice data from 45 countries that included patients with coronary artery disease and hypertension, SBP <120 mm Hg and DBP <70 mm Hg were associated with higher mortality(18). We found that deaths due to non-cardiovascular/non-malignancy causes were also higher with lower DBP and SBP levels.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure parameters are associated with all-cause and cause-specific mortality in chronic kidney disease

Navaneethan

Schold

Jolly

et al. 2017

Kidney International

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Previous observational studies reported J or U-shaped associations between blood pressure parameters and mortality in patients with chronic kidney disease (CKD). Here we examined the associations of different blood pressure levels with various causes of death in a CKD population that included patients with eGFR 15–59 ml/min/1.73 m2 with underlying hypertension receiving at least one antihypertensive agent. We obtained data on date and cause of death from State Department of Health mortality files and classified deaths into three categories: cardiovascular; malignancy-related; and non-cardiovascular/non-malignancy related. Cox models were fitted for overall mortality, and separate competing risk regression models for each major cause of death category, to evaluate their associations with various systolic and diastolic blood pressures. During a median follow-up of 3.9 years, 13,332 of 45,412 patients died. Systolic blood pressures under 100, 100–109, 110–119, and over 150 (vs. 130–139 mm Hg) were associated with higher all-cause and cardiovascular mortality. Systolic blood pressures under 100 mm Hg and 100–109 were associated with higher non-cardiovascular/non-malignancy related mortality. Diastolic blood pressures under 50 and 50–59 (vs. 70–79 mm Hg) were associated with higher all-cause and non-cardiovascular/non-malignancy-related mortality while diastolic blood pressures over 90 mm Hg was associated with higher cardiovascular but lower non-cardiovascular/non-malignancy related mortality. Thus, in a non-dialysis dependent CKD population, systolic blood pressures under110 and over 150 mm Hg were associated with cardiovascular and non-cardiovascular/non-malignancy related deaths. However, diastolic blood pressures under 60 mm Hg was associated in contrast, with all-cause mortality and non-cardiovascular/non-malignancy-related deaths.

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“…Although diastolic BP (DBP) of <90 mm Hg is recommended in the current guidelines, studies using J curves have indicated that cardiovascular risk increases at <60 to 70 mm Hg 9, 10. Therefore, we also aimed to determine whether DBP lowering at <80 mm Hg was beneficial in poststroke hypertensive subjects.…”

Section: Methodsmentioning

confidence: 99%

Relation Between Blood Pressure and Clinical Outcome in Hypertensive Subjects With Previous Stroke

Park

Hwang

et al. 2017

JAHA

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BackgroundThis study investigated whether a mean blood pressure (BP) of <130/80 mm Hg is associated with further reduction in cardiovascular outcomes in treated hypertensive subjects with previous stroke.Methods and ResultsSubjects from the Korea National Health Insurance Service health examinee cohort diagnosed as having stroke and hypertension from January 1st, 2003 and December 31st, 2006 (N=2320) were grouped according to mean systolic (<130, 130–<140, and ≥140 mm Hg) and diastolic (<80, 80–<90, and ≥90 mm Hg) BP recorded during follow‐up health examinations. All‐cause and cardiovascular mortality over 11 years were compared. Compared with subjects with a systolic BP of ≥140 mm Hg (N=736), subjects with a systolic BP of 130 to <140 mm Hg (N=793) had a significantly lower risk of all‐cause death (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.47–0.79; P<0.001), cardiovascular mortality (HR, 0.39; 95% CI, 0.25–0.61; P<0.001), and fatal ischemic stroke (HR, 0.25; 95% CI, 0.10–0.63; P=0.003). Systolic BP of <130 mm Hg (N=791) was associated with lower risk of nonfatal hemorrhagic stroke. Subjects with a diastolic BP of 80 to <90 mm Hg (N=1100) had significantly lower risk of all‐cause death (HR, 0.60, 95% CI, 0.45–0.80; P<0.001) and cardiovascular mortality (HR, 0.45; 95% CI, 0.30–0.70; P<0.001) than those with a diastolic BP of ≥90 mm Hg (N=342). Diastolic BP of <80 mm Hg (N=878) was associated with reduced risk of nonfatal hemorrhagic stroke and further lowering of all‐cause mortality and cardiovascular mortality.ConclusionsBP of <130/80 mm Hg was associated with improved outcomes in hypertensive subjects with previous stroke.

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Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study

Cited by 379 publications

References 31 publications

Relation of Diastolic Blood Pressure and Coronary Artery Calcium to Coronary Events and Outcomes (From the Multi-Ethnic Study of Atherosclerosis)

Relation of Diastolic Blood Pressure and Coronary Artery Calcium to Coronary Events and Outcomes (From the Multi-Ethnic Study of Atherosclerosis)

Blood pressure parameters are associated with all-cause and cause-specific mortality in chronic kidney disease

Relation Between Blood Pressure and Clinical Outcome in Hypertensive Subjects With Previous Stroke

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