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Potential impact of the 2017 ACC/AHA guideline on high blood pressure in normotensive patients with stable coronary artery disease: insights from the CLARIFY registry.


ABSTRACT: Aims:The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline on high blood pressure (BP) lowered the threshold defining hypertension and BP target in high-risk patients to 130/80?mmHg. Patients with coronary artery disease and systolic BP 130-139?mmHg or diastolic BP 80-89?mmHg should now receive medication to achieve this target. We aimed to investigate the relationship between BP and cardiovascular events in 'real-life' patients with coronary artery disease considered as having normal BP until the recent guideline. Methods and results:Data from 5956 patients with stable coronary artery disease, no history of hypertension or heart failure, and average BP <140/90?mmHg, enrolled in the CLARIFY registry (November 2009 to June 2010), were analysed. In a multivariable-adjusted Cox proportional hazards model, after a median follow-up of 5.0?years, diastolic BP 80-89?mmHg, but not systolic BP 130-139?mmHg, was associated with increased risk of the primary endpoint, a composite of cardiovascular death, myocardial infarction, or stroke (hazard ratio 2.15, 95% confidence interval 1.22-3.81 vs. 70-79?mmHg and 1.12, 0.64-1.97 vs. 120-129?mmHg). No significant increase in risk for the primary endpoint was observed for systolic BP <120?mmHg or diastolic BP <70?mmHg. Conclusion:In patients with stable coronary artery disease defined as having normal BP according to the 140/90?mmHg threshold, diastolic BP 80-89?mmHg was associated with increased cardiovascular risk, whereas systolic BP 130-139?mmHg was not, supporting the lower diastolic but not the lower systolic BP hypertension-defining threshold and treatment target in coronary artery disease. ClinicalTrials identifier:ISRCTN43070564.

SUBMITTER: Vidal-Petiot E 

PROVIDER: S-EPMC6234847 | BioStudies | 2018-01-01

REPOSITORIES: biostudies

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