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Potential Impact of ACC/AHA Hypertension Guideline on Normotensive CAD Patients
Study Questions:
What is the relationship between blood pressure (BP) and cardiovascular events in “real-life” patients with coronary artery disease (CAD) with newly diagnosed hypertension, based on the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines?
Methods:
Data from 5,956 patients with stable CAD, no history of hypertension, and an average BP <140/90 mm Hg were analyzed from the CLARIFY registry. The primary endpoint was a composite of cardiovascular death, myocardial infarction, or stroke. Multivariable Cox proportional hazard model was used to associate BP with the primary outcome.
Results:
After a median follow-up of 5 years, a diastolic BP 80-89 mm Hg was associated with an increased risk of the primary composite outcome (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.22-3.81) as compared to patients with a diastolic BP 70-79 mm Hg. There was no significantly increased risk of the composite outcome among patients with a systolic BP of 130-139 mm Hg as compared to 120-129 mm Hg (HR, 1.12; 95% CI, 0.64-1.97).
Conclusions:
The authors concluded that among patients with known CAD, an elevated diastolic BP of 80-89 mm Hg, but not an elevated systolic BP of 130-139 mm Hg, is associated with worse outcomes.
Perspective:
Since the 2017 ACC/AHA hypertension guidelines were first released, there has been considerable debate about defining patients with an average systolic BP >130 mm Hg or an average diastolic BP >80 mm Hg as hypertensive. Even more controversial is the recommendation for these patients to receive antihypertensive therapy. This analysis of a practice-based cohort of patients with prior CAD demonstrated an increased risk of serious cardiovascular events in patients with elevated diastolic, but not systolic, BP. While this observational study does not confirm a treatment benefit in patients with elevated diastolic BP, multiple studies have demonstrated an increased risk in this population. Therefore, it is reasonable to initiate antihypertension therapy for patients with diastolic BP 80-89 mm Hg. Further data are needed on the potential benefits of treating systolic BP of 130-139 mm Hg among patients with prior CAD.
Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Atherosclerotic Disease (CAD/PAD), Hypertension
Keywords: Antihypertensive Agents, Atherosclerosis, Blood Pressure, Coronary Artery Disease, Diastole, Hypertension, Myocardial Infarction, Primary Prevention, Risk Factors, Stroke, Vascular Diseases
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