19 Sep Systolic blood pressure target 130-140 may be associated with the lowest risk of all-cause mortality
MedicalResearch.com Interview with:
Islam Elgendy, MD
Cardiology Fellow
University of Florida
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The optimal systolic blood pressure target in adults with coronary artery disease is not well known. The Eighth Joint National Committee Panel recommended a target therapeutic goal <150 mm Hg for adults aged ≥60 years and <140 mm Hg in those aged <60 years. These recommendations are inconsistent with the different society guidelines (such as American Heart Association/American College of Cardiology, European Society of Cardiology, and American Society of Hypertension) which recommended a therapeutic target < 140 mm Hg. Given that the dyad of hypertension and coronary artery disease is the most prevalent chronic disease dyad among adults, we aimed to assess the long term risk of all-cause mortality with the different systolic blood pressure targets.
Using the extended follow-up data from the US cohort of the INVEST trial, we demonstrated that achieving a systolic blood pressure of 130 to <140 mm Hg in the initial 2-3 years of treatment is associated with reduced all-cause mortality after ≈11.6 years of follow-up in hypertensive patients with coronary artery disease.
MedicalResearch.com: What should readers take away from your report?
Response: This report is probably the first study relating achieved systolic blood pressure to long term mortality. This study suggests that achieving a systolic blood pressure target 130-140 mm Hg is associated with the lowest risk of all-cause mortality.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Given that our study is observational in nature, randomized trials are recommended to ascertain these findings. Moreover, future studies are needed to determine the risk of adverse events (such as renal failure) associated with a lower systolic blood pressure target in this population.
MedicalResearch.com: Is there anything else you would like to add?
Response: The recently published Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated a reduction in the composite outcome of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes with intense blood pressure control (i.e., systolic blood pressure < 120 mm Hg), however the risk of absolute reduction in all-cause mortality was 1.2% (number needed to treat=83) over a median of 3.3 years, while the risk of adverse events such as renal failure (number needed to harm=63) and profound hypotension (number needed to harm=59) was higher in the intense blood pressure reduction group. The results from our study disprove the suggestions that all high risk hypertensive patients irrespective of age should be treated to a lower systolic blood pressure target.
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Citation:
Long-Term Mortality in Hypertensive Patients With Coronary Artery Disease
Results From the US Cohort of the International Verapamil (SR)/Trandolapril Study
Islam Y. Elgendy, Anthony A. Bavry, Yan Gong, Eileen M. Handberg, Rhonda M. Cooper-DeHoff and Carl J. Pepine
http://dx.doi.org/10.1161/HYPERTENSIONAHA.116.07854
Published Ahead of Print: September 12, 2016
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Last Updated on September 19, 2016 by Marie Benz MD FAAD