open access

Vol 25, No 3 (2018)
Original articles — Clinical cardiology
Published online: 2017-09-13
Get Citation

Low diastolic blood pressure is associated with a high atherosclerotic burden in patients with obstructive coronary artery disease

Vichai Senthong, Upa Kukongviriyapan, Nongnuch Settasatian, Chatri Settasatian, Nantarat Komanasin
DOI: 10.5603/CJ.a2017.0109
·
Pubmed: 28980283
·
Cardiol J 2018;25(3):345-352.

open access

Vol 25, No 3 (2018)
Original articles — Clinical cardiology
Published online: 2017-09-13

Abstract

Background: The optimal blood pressure (BP) treatment target is still being debated, specifically di­astolic BP (DBP) in patients with obstructive coronary artery disease (CAD); a DBP which is too low could compromise myocardial perfusion and is associated with adverse outcomes.

Methods: This study examined the relationship between DBP levels and the severity and atheroscle­rotic burden of CAD in 231 consecutive stable patients with evidence of obstructive CAD as detected by elective coronary angiography. The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) Score and SYNTAX Score II were used to quantify the atherosclerotic burden.

Results: The patients were male (71%), median age 62, interquartile range [IQR] of 57 to 67, and 84% had hypertension. The median DBP was 71.0 mmHg (IQR: 61 to 80) and the median SYNTAX Score was 16.0 (IQR 9.0–23.0). DBP levels were inversely correlated with SYNTAX Score (r = –0.61) and SYNTAX Score II (r = –0.73). Adjusting for traditional risk factors, unprotected left main CAD, systolic BP, renal function, and medications, DBP levels remained independently inversely associated with a higher tertile of SYNTAX Score (adjusted odds ratio [OR] 0.89; 95% confidence interval [CI] 0.85–0.92, p < 0.001) and SYNTAX Score II (adjusted OR 0.75; 95% CI 0.69–0.80, p < 0.001). The frequency of high athero­sclerotic burden identified by the presence of intermediate or high SYNTAX Score and SYNTAX Score II was significantly higher among patients with a DBP < 60 mmHg.

Conclusions: Low DBP levels are independently associated with high SYNTAX Score and SYNTAX Score II in stable patients with obstructive CAD.

Abstract

Background: The optimal blood pressure (BP) treatment target is still being debated, specifically di­astolic BP (DBP) in patients with obstructive coronary artery disease (CAD); a DBP which is too low could compromise myocardial perfusion and is associated with adverse outcomes.

Methods: This study examined the relationship between DBP levels and the severity and atheroscle­rotic burden of CAD in 231 consecutive stable patients with evidence of obstructive CAD as detected by elective coronary angiography. The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) Score and SYNTAX Score II were used to quantify the atherosclerotic burden.

Results: The patients were male (71%), median age 62, interquartile range [IQR] of 57 to 67, and 84% had hypertension. The median DBP was 71.0 mmHg (IQR: 61 to 80) and the median SYNTAX Score was 16.0 (IQR 9.0–23.0). DBP levels were inversely correlated with SYNTAX Score (r = –0.61) and SYNTAX Score II (r = –0.73). Adjusting for traditional risk factors, unprotected left main CAD, systolic BP, renal function, and medications, DBP levels remained independently inversely associated with a higher tertile of SYNTAX Score (adjusted odds ratio [OR] 0.89; 95% confidence interval [CI] 0.85–0.92, p < 0.001) and SYNTAX Score II (adjusted OR 0.75; 95% CI 0.69–0.80, p < 0.001). The frequency of high athero­sclerotic burden identified by the presence of intermediate or high SYNTAX Score and SYNTAX Score II was significantly higher among patients with a DBP < 60 mmHg.

Conclusions: Low DBP levels are independently associated with high SYNTAX Score and SYNTAX Score II in stable patients with obstructive CAD.

Get Citation

Keywords

hypertension, diastolic blood pressure, coronary artery disease, J-curve phenomenon, SYNTAX Score, atherosclerosis

About this article
Title

Low diastolic blood pressure is associated with a high atherosclerotic burden in patients with obstructive coronary artery disease

Journal

Cardiology Journal

Issue

Vol 25, No 3 (2018)

Pages

345-352

Published online

2017-09-13

DOI

10.5603/CJ.a2017.0109

Pubmed

28980283

Bibliographic record

Cardiol J 2018;25(3):345-352.

Keywords

hypertension
diastolic blood pressure
coronary artery disease
J-curve phenomenon
SYNTAX Score
atherosclerosis

Authors

Vichai Senthong
Upa Kukongviriyapan
Nongnuch Settasatian
Chatri Settasatian
Nantarat Komanasin

References (22)
  1. Mozaffarian D, Benjamin EJ, Go AS, et al. Writing Group Members, American Heart Association Statistics Committee, Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016; 133(4): e38–360.
  2. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311(5): 507–520.
  3. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016; 387(10022): 957–967.
  4. Kjeldsen SE, Lund-Johansen P, Nilsson PM, et al. Unattended blood pressure measurements in the systolic blood pressure intervention trial: implications for entry and achieved blood pressure values compared with other trials. Hypertension. 2016; 67(5): 808–812.
  5. Mancia G, Grassi G. Aggressive blood pressure lowering is dangerous: the J-curve: pro side of the arguement. Hypertension. 2014; 63(1): 29–36.
  6. Wright JT, Williamson JD, Whelton PK, et al. SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015; 373(22): 2103–2116.
  7. Bangalore S, Messerli FH, Wun CC, et al. Treating to New Targets Steering Committee and Investigators. J-curve revisited: An analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Heart J. 2010; 31(23): 2897–2908.
  8. Messerli FH, Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006; 144(12): 884–893.
  9. Messerli FH, Panjrath GS. The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential? J Am Coll Cardiol. 2009; 54(20): 1827–1834.
  10. McEvoy JW, Chen Y, Rawlings A, et al. Diastolic blood pressure, subclinical myocardial damage, and cardiac events: implications for blood pressure control. J Am Coll Cardiol. 2016; 68(16): 1713–1722.
  11. Vidal-Petiot E, Ford I, Greenlaw N, et al. CLARIFY Investigators. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet. 2016; 388(10056): 2142–2152.
  12. Ikeda N, Kogame N, Iijima R, et al. Carotid artery intima-media thickness and plaque score can predict the SYNTAX score. Eur Heart J. 2012; 33(1): 113–119.
  13. Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005; 1(2): 219–227.
  14. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013; 381(9867): 629–638.
  15. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009; 360(10): 961–972.
  16. Farooq V, van Klaveren D, Steyerberg EW, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet. 2013; 381(9867): 639–650.
  17. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014; 64(18): 1929–1949.
  18. Hillis LD, Smith PK, Anderson JL, et al. American College of Cardiology Foundation, American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, Society of Thoracic Surgeons. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011; 58(24): e123–e210.
  19. Xu Bo, Généreux P, Yang Y, et al. Validation and comparison of the long-term prognostic capability of the SYNTAX score-II among 1,528 consecutive patients who underwent left main percutaneous coronary intervention. JACC Cardiovasc Interv. 2014; 7(10): 1128–1137.
  20. Lonn EM, Bosch J, López-Jaramillo P, et al. HOPE-3 Investigators. Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med. 2016; 374(21): 2009–2020.
  21. Brunström M, Carlberg Bo. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ. 2016; 352: i717.
  22. Bakris GL. The implications of blood pressure measurement methods on treatment targets for blood pressure. Circulation. 2016; 134(13): 904–905.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl