Intensive blood pressure treatment in coronary artery disease: implications from the Systolic Blood Pressure Intervention Trial (SPRINT)

Abstract

To investigate the optimal blood pressure (BP) in patients with coronary artery disease (CAD), we conducted subgroup analysis using SPRINT data. The study sample included 1206 participants with CAD (of whom 692 underwent coronary revascularization) and 8127 participants without CAD. Participants were randomized into two groups (systolic BP target of 140 mm Hg vs. 120 mm Hg). The primary outcome was a composite of cardiovascular events. After a median follow-up of 3.9 years, the hazard ratios (HRs) for the primary outcome were 0.65 (95% confidence interval (CI) 0.53–0.79) and 1.05 (95% CI 0.76–1.46) among those in the non-CAD and CAD subgroups, respectively (P value for interaction 0.02). Intensive BP treatment was a protective factor for all-cause death (HR 0.60, 95% CI 0.37–0.96) in the CAD subgroup, compared with standard BP treatment. The HRs (95% CI) for stroke were 3.57 (1.17–10.85) and 1.03 (0.29–3.62) among those in the coronary revascularization and non-revascularization subgroups, respectively (P value for interaction 0.13). For safety events, intensive BP treatment increased the risk of hypotension (HR 2.00, 95% CI 1.06–3.79) and electrolyte abnormalities (HR 2.38, 95% CI 1.25–4.56) in the CAD subgroup, while the risk of serious adverse events did not increase (HR 1.03, 95% CI 0.88–1.20). These results suggest that positive benefits from intensive BP treatment might be attenuated in patients with CAD who are under better secondary prevention. The risk of stroke might increase at the systolic BP target of 120 mm Hg in case of coronary revascularization, although the confidence interval was wide.

Variability independent of mean blood pressure as a real-world measure of cardiovascular risk

“…This is similarly true for those with diabetes mellitus, coronary artery disease and renal dysfunction. 31 , 32 , 33 , 34 We found that VIM was positively associated with the composite outcome in stratified analyses of each of these subgroups, as well as among patients with a diagnosis of hypertension. These results indicate that VIM may serve as a risk marker independent of mean BP, helping to further clarify risk among populations in whom BP thresholds may vary from the general population.…”

Highlights of the 2022 Vietnamese Society of Hypertension guidelines for the diagnosis and treatment of arterial hypertension

“… 30 Bohm's study noted that reperfusion eliminates risk at low DBP by maintaining perfusion pressure 31 and the next meta‐analysis found no evidence for a nonlinear J‐ or U‐shaped relationship between DBP and adverse CVD outcomes; including MI. 32 , 33 , 34 , 35 , 36 Therefore, the 2021 ESC Guidelines for CVD prevention modified the therapy target range in clinical practice. 37 Significantly, based on Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline 2021, 3 we suggest the office BP treatment initiation thresholds and on‐treatment targets as shown in Figure 2 .…”

“… General treatment algorithm for hypertension by office blood pressure. 2 , 3 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 CV, Cardiovascular; CVD, cardiovascular disease; CKD, chronic kidney disease; DM, diabetes mellitus; ASCVD: atherosclerotic cardiovascular disease; SBP, systolic blood pressure; DBP, diastolic blood pressure. …”

Patients with comorbid coronary artery disease and hypertension: a cross-sectional study with data from the NHANES

“…Granger et al revealed that the in-hospital mortality rate of acute coronary syndrome (ACS) patients with HTN was significantly higher than that without HTN (10). Previous studies showed that 50-60% CAD patients had comorbid HTN, and 13% HTN patients had comorbid CAD, implying a high prevalence of comorbid CAD and HTN in the general population (11)(12)(13).…”

“…Granger et al revealed that the in-hospital mortality rate of acute coronary syndrome (ACS) patients with HTN was significantly higher than that without HTN ( 10 ). Previous studies showed that 50–60% CAD patients had comorbid HTN, and 13% HTN patients had comorbid CAD, implying a high prevalence of comorbid CAD and HTN in the general population ( 11 - 13 ). The high prevalence and worse outcomes of comorbid CAD and HTN could cause a tremendous threat and burden to public health and should be paid more attention by patients, physicians and healthcare provider.…”