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Relationship between blood pressure and adverse clinical events in patients undergoing percutaneous coronary
Zhaochong Tan1, Ping Yuan2, Ying Huang3
1School of Medicine, Yichun University, Yichun, 336000, Jiangxi, China.
Insights
Lowering systolic blood pressure (BP) to 95-107 mmHg in coronary heart disease (CHD) patients after percutaneous coronary intervention (PCI) may reduce adverse outcomes. This finding contrasts with some guidelines, highlighting a potential U-shaped risk correlation.
Area of Science:
- Cardiology
- Hypertension Management
- Interventional Cardiology
Background:
- Recent US guidelines recommend lower blood pressure (BP) targets for hypertension.
- Excessively low BP may worsen myocardial ischemia-reperfusion injury in coronary heart disease (CHD) patients.
Purpose of the Study:
- To evaluate the impact of BP lowering on adverse clinical outcomes in CHD patients post-percutaneous coronary intervention (PCI).
Main Methods:
- 1670 CHD patients who underwent PCI were analyzed from the Dryad database.
- Primary outcomes included major adverse clinical events, all-cause death, and cardiac death over a median 29.8-month follow-up.
Main Results:
- A U-shaped correlation was observed between systolic BP and adverse outcomes.
- The lowest risk for major clinical events, all-cause death, and cardiac death occurred at systolic BP levels of 95 mmHg, 105 mmHg, and 107 mmHg, respectively.
Conclusions:
- Targeting systolic BP within the 95-107 mmHg range may reduce adverse outcomes in CHD patients post-PCI.
- Further cohort studies are necessary to validate these findings.
Background:
Recent guideline from the United States has a positive recommendation on lowering blood pressure (BP) target for patients with hypertension. However, excessively lowering BP might result in a possible deterioration of myocardial ischemia-reperfusion injury, especially in patients with coronary heart disease (CHD).
Objective:
We aimed to assess the impact of lowering BP on the risk for adverse clinical outcomes among CHD patients who have undergone percutaneous coronary intervention (PCI).
Methods:
A total of 1670 consecutive patients with CHD from the Dryad database who have undergone PCI were enrolled in our study. The primary outcomes were defined as adverse clinical events, all-cause death and cardiac death at the follow-up for a median of 29.8 months.
Results:
Among these patients, the rate of major clinical events in these CHD patients was 191 (11.4%). The all-cause death and cardiac death of these patients with clinical events was 120 (62.8%) and 80 (41.9%), respectively. A smooth curve from a real world showed a U-shaped correlation between systolic BP and the rate of primary outcomes including major clinical events, all-cause death and cardiac death, respectively. Diastolic BP tended to have a positive correlation with these outcomes. Further results did show a turning point in the associations of systolic BP with major clinical events, all-cause death and cardiac death, respectively. When the systolic BP level was at 95 mmHg, 105 mmHg and 107 mmHg, respectively, these CHD patients had the lowest risk for the major clinical events, all-cause death and cardiac death.
Conclusion:
Our results demonstrated that accurately lowering systolic BP at a range of 95-107 mmHg may obtain benefits from reducing adverse outcomes including all-cause death and cardiac death for patients with CHD after undergoing PCI. However, further cohort study is needed to support our results.
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