In patients with stable CAD, BP below 120 mm Hg systolic or 70 mm Hg diastolic was associated with elevated risk for CV death, MI and stroke, according to findings from the CLARIFY registry.
“Some argue ‘the lower, the better’, but there is a concern that patients with [CAD] may have insufficient blood flow to the heart if their [BP] is too low,” Philippe Gabriel Steg, MD, from the cardiology and physiology departments, Départment Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris Diderot University, Sorbonne Paris Cité, France, said in a press release.
Steg and colleagues analyzed data from 22,672 patients (mean age, 65 years; 75% men) with stable CAD from 45 countries who were treated for hypertension between November 2009 and June 2010.
Philippe Gabriel Steg
The primary outcome was a composite of CV death, MI or stroke. Secondary outcomes included each component of the primary outcome, all-cause death and hospitalization for HF. Median follow-up was 5 years.
Patients were stratified by systolic and diastolic BP levels of 10 mm Hg increments, with 120-129 mm Hg systolic BP and 70-79 mm Hg diastolic BP serving as the reference groups.
Systolic BP > 140 mm Hg (adjusted HR = 1.51; 95% CI, 1.32-1.73) and diastolic BP > 80 mm Hg (adjusted HR = 1.41; 95% CI, 1.27-1.57) were each associated with increased risk for the primary outcome at the end of the study period.
However, systolic BP < 120 mm Hg (adjusted HR = 1.56; 95% CI, 1.36-1.81) and diastolic BP < 70 mm Hg (adjusted HR = 1.41; 95% CI, 1.24-1.61) were also associated with increased risk for the primary outcome, with a larger risk seen in those with diastolic BP < 60 mm Hg (adjusted HR = 2.01; 95% CI, 1.5-2.7).
“Our observations are in agreement with the fact that after decades of hypertension trials, the benefit of lowering [BP] to less than 140 mm Hg remains unquestionable, whereas the benefit of lowering [BP] to less than 130 mm Hg is uncertain,” the researchers wrote in The Lancet.
Steg, a member of the Cardiology Today’s Intervention Editorial Board, said in the release that “the findings support the existence of a J-curve phenomenon, where the initial lowering of BP is beneficial but further lowering is harmful.” – by James Clark
Steg PG, et al. Registries miscellaneous. Presented at: European Society of Cardiology Congress; Aug. 27-31, 2016; Rome.
Vidal-Petiot E, et al. Lancet. 2016;doi:10.1016/S0140-6736(16)31326-5.
Disclosures: The registry was funded by Servier. Steg reports financial ties with Amarin, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CSL Behring, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Janssen, Medtronic, Merck, Novartis, Pfizer, Regeneron, Roche, Servier and The Medicines Company.