The association between blood pressure and long-term outcomes of patients with ischaemic cardiomyopathy with and...

Area of Science:

• Cardiology
• Clinical Trials
• Hypertension Research

Background:

• Hypertension (HTN) is a major risk factor for cardiovascular diseases like heart failure (HF) and coronary artery disease (CAD).
• A J- or U-shaped relationship between blood pressure (BP) and clinical outcomes is suggested, but data is limited for patients with CAD and left ventricular dysfunction.

Purpose of the Study:

• To investigate the association between blood pressure (BP) and mortality outcomes in patients with ischemic cardiomyopathy.
• To determine the optimal BP range for improved survival in this patient population.

Main Methods:

• Analysis of 1212 patients from the STICH trial with ejection fraction ≤35% and coronary disease.
• Landmark analyses of average systolic BP (SBP) and diastolic BP (DBP) at 1, 2, 3, 4, and 5 years post-randomization, relating it to subsequent mortality over a median 9.8-year follow-up.
• Comparison of outcomes between CABG and medical therapy (MED) groups, with no significant interaction found regarding BP.

Main Results:

• A significant U-shaped relationship between BP and mortality was observed in patients with ischemic heart failure.
• The most favorable outcomes were associated with SBP of 120-130 mmHg and DBP of 75-85 mmHg.
• Both lower and higher BP levels were linked to increased mortality risk, with the U-shaped relationship strengthening over time.

Conclusions:

• A strong U-shaped relationship exists between BP and mortality in ischemic heart failure patients.
• Optimal SBP appears to be in the 120-130 mmHg range post-intervention, suggesting potential targets for pharmacologic management of high BP.
• Low BP is identified as a marker of poor prognosis, necessitating further investigation into tailored treatment strategies.