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Low DBP may not be an independent risk for cardiovascular death in revascularized coronary artery disease patients

Hisashi Kai1, Takafumi Ueno, Takeshi Kimura

  • 1Division of Cardio-vascular Medicine, Department of Internal Medicine, Kurume, Japan. naikai@med.kurume-u.ac.jp

Journal of Hypertension
|August 23, 2011
PubMed

Insights

Extremely low diastolic blood pressure (DBP) may not significantly increase cardiovascular death risk in revascularized coronary artery disease (CAD) patients after accounting for other health factors. Renal insufficiency and heart dysfunction are key predictors of mortality in these patients.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Clinical Research

Background:

  • The cardiovascular risk associated with extremely low diastolic blood pressure (DBP) in patients with coronary artery disease (CAD) undergoing revascularization remains debated.
  • Coronary revascularization procedures, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), are increasingly common in CAD management.

Purpose of the Study:

  • To evaluate the impact of low preprocedural DBP on cardiovascular events in patients with CAD who have undergone revascularization.
  • To identify independent predictors of cardiovascular death in revascularized CAD patients with low DBP.

Main Methods:

  • A subanalysis of 7180 stable, chronic CAD patients from the Coronary REvascularization Demonstrating Outcome study in Kyoto (CREDO-Kyoto) registry was performed.
  • Patients underwent first-time CABG or PCI, with a median follow-up of 3.6 years.
  • Kaplan-Meier analysis and stepwise logistic regression were used to assess cardiovascular outcomes and risk factors.

Main Results:

  • Unadjusted analysis showed a higher incidence of cardiovascular death in patients with preprocedural DBP < 70 mmHg compared to those with DBP ≥ 70 mmHg.
  • However, incidences of nonfatal myocardial infarction and stroke were similar between groups.
  • Independent risk factors for cardiovascular death in patients with DBP < 70 mmHg included impaired estimated glomerular filtration ratio, pulse pressure, low left ventricular ejection fraction, heart failure history, prior cerebrovascular disease, and prior myocardial infarction.

Conclusions:

  • Renal insufficiency, advanced vascular damage, and left ventricular systolic dysfunction are significant contributors to increased cardiovascular death in revascularized CAD patients with low DBP.
  • After adjusting for these independent risk factors, low DBP (< 70 mmHg) was not found to be a significant independent risk for cardiovascular death in this patient cohort.
Abstract

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