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Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based
Juan F Sánchez Muñoz-Torrero1, Guillermo Escudero-Sánchez2, Julián F Calderón-García3
1Department of Internal Medicine, Hospital San Pedro Alcántara, 10003 Cáceres, Spain.
Insights
Systolic blood pressure (SBP) targets for patients with symptomatic artery disease are debated. Lower SBP (<130 mm Hg) may increase mortality in cerebrovascular or peripheral artery disease patients, warranting further research.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Epidemiology
Background:
- Optimal systolic blood pressure (SBP) targets for reducing cardiovascular events in patients with symptomatic artery disease are not well-established.
- Existing clinical trial data may not fully represent real-world patient populations with diverse vascular conditions.
Purpose of the Study:
- To investigate the association between mean systolic blood pressure (SBP) levels and the risk of subsequent ischemic events or death in patients with symptomatic artery disease.
- To compare cardiovascular outcomes based on different SBP ranges in a real-world cohort.
Main Methods:
- A prospective cohort study (FRENA registry) involving 4789 stable outpatients with symptomatic coronary artery disease (CAD), cerebrovascular disease (CVD), or peripheral artery disease (PAD) across 24 Spanish hospitals.
- Patients were followed for a mean of 18 months, with subsequent ischemic events (myocardial infarction, ischemic stroke, limb amputation) and mortality recorded.
- Multivariable analysis was used to assess the relationship between mean SBP levels and adverse outcomes.
Main Results:
- In patients with cerebrovascular disease (CVD), SBP levels of 130-140 mm Hg and >140 mm Hg were associated with a lower risk of mortality compared to SBP <130 mm Hg.
- For peripheral artery disease (PAD) patients, SBP >140 mm Hg correlated with a reduced risk of subsequent ischemic events, and SBP levels of 130-140 mm Hg or >140 mm Hg were linked to lower mortality.
- No significant differences in outcomes were observed for patients with coronary artery disease (CAD) based on SBP levels.
Conclusions:
- In a real-world cohort, SBP <130 mm Hg may be associated with increased mortality in patients with peripheral artery disease (PAD) or cerebrovascular disease (CVD).
- The risk of adverse events and death varies by SBP levels and the specific type of arterial disease.
- Further prospective studies are needed to confirm these observational findings and inform optimal SBP management strategies.
Objectives:
The most appropriate targets for systolic blood pressure (SBP) levels to reduce cardiovascular morbidity and mortality in patients with symptomatic artery disease remain controversial. We compared the rate of subsequent ischemic events or death according to mean SBP levels during follow-up.
Design:
Prospective cohort study. FRENA is an ongoing registry of stable outpatients with symptomatic coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD).
Setting:
24 Spanish hospitals.
Participants:
4789 stable outpatients with vascular disease.
Results:
As of June 2017, 4789 patients had been enrolled in different Spanish centres. Of these, 1722 (36%) had CAD, 1383 (29%) CVD and 1684 (35%) PAD. Over a mean follow-up of 18 months, 136 patients suffered subsequent myocardial infarction, 125 had ischemic stroke, 74 underwent limb amputation, and 260 died. On multivariable analysis, CVD patients with mean SBP levels 130-140 mm Hg had a lower risk of mortality than those with levels <130 mm Hg (hazard ratio (HR): 0.39; 95% CI: 0.20-0.77), as did those with levels >140 mm Hg (HR: 0.46; 95% CI: 0.26-0.84). PAD patients with mean SBP levels >140 mm Hg had a lower risk for subsequent ischemic events (HR: 0.57; 95% CI: 0.39-0.83) and those with levels 130-140 mm Hg (HR: 0.47; 95% CI: 0.29-0.78) or >140 mm Hg (HR: 0.32; 95% CI: 0.21-0.50) had a lower risk of mortality. We found no differences in patients with CAD.
Conclusions:
In this real-world cohort of symptomatic arterial disease patients, most of whom are not eligible for clinical trials, the risk of subsequent events and death varies according to the levels of SBP and the location of previous events. Especially among patients with large artery atherosclerosis, PAD or CVD, SBP <130 mm Hg may result in increased mortality. Due to potential factors in this issue, Prospective, well designed studies are warranted to confirm these observational data.
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