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. 2021 Sep 4;18(17):9348.
doi: 10.3390/ijerph18179348.

Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study

Juan F Sánchez Muñoz-Torrero  1 , Guillermo Escudero-Sánchez  2 , Julián F Calderón-García  3 , Sergio Rico-Martín  3 , Nicolás Roberto Robles  4 , M Asunción Bacaicoa  5 , José N Alcalá-Pedrajas  6 , Guadalupe Gil-Fernández  7 , Manuel Monreal  8 , On Behalf Of The Frena Investigators
Affiliations

Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study

Juan F Sánchez Muñoz-Torrero et al. Int J Environ Res Public Health. .

Abstract

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.

Keywords: death; ischemic event; outcomes; symptomatic artery disease; systolic blood pressure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Participant selection process.
Figure 2
Figure 2
Proposed mechanism of destabilization of a coronary plaque by distal ischemia. A patient with PAD and ABI of 0.4 may have SBP leg lower of 44 mm Hg to a brachial SBP of 110 mm Hg. Local detrimental mediators, free oxygen radicals or inflammatory mediators bloodborne can produce a myocardial event by destabilize a coronary plaque. Abbreviations: ABI, ankle brachial index; SBP, systolic blood pressure.
See this image and copyright information in PMC

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