Abstract 20094: Achieved Blood Pressure Targets and Cardiovascular Outcomes in Stable Ischemic Heart Disease: a Post Hoc Analysis from the COURAGE trial
Background: Significant uncertainty exists regarding the relationship between achieved blood pressure (BP) ranges and long-term cardiovascular outcomes in patients with stable ischemic heart disease (SIHD). The purpose of this analysis was to identify ideal BP treatment goals in SIHD patients treated with aggressive lifestyle and pharmacologic therapy with or without percutaneous intervention.
Methods: From the COURAGE trial, 2,177 patients were categorized into subgroups based on 10 mmHg increments of average on-treatment BP (systolic and diastolic). Rates of death or myocardial infarction (MI) over 4.6 years of follow-up were compared using an adjusted nonlinear Cox proportional hazards model in the overall group, and separately in those ≤60 or >60 years of age.
Results: A U- and J-shaped relationship was noted between the risk of death/MI and average systolic and diastolic BP, respectively, in the overall cohort. This association was apparent in unadjusted analyses, and persisted after adjustment for baseline variables and on-treatment average low-density lipoprotein cholesterol. A marked difference was noted in the shape of these curves in age-based analyses, particularly at lower ranges of BP. (Figure)
Conclusions: In SIHD patients treated with contemporary optimal medical therapy, the association between average BP and long-term cardiovascular risk is not linear. While an exponential increase in cardiovascular events was noted at both extremes of systolic BP (≤100 or ≥150 mmHg), only those with abnormally elevated diastolic BP(≥90 mmHg) experienced excessive risk. The lowest hazard appeared to be in the 130-140 mmHg and 120-130 mmHg systolic BP ranges for the overall cohort and those >60 years of age, respectively. For diastolic BP, the 70-80 mmHg range was least hazardous regardless of age. Although post-hoc, our findings nevertheless appear to be at variance with recent guideline-recommended BP targets, particularly among those >60 years of age.
Author Disclosures: S. Acharjee: None. V. Figueredo: None. P. Hartigan: None. K. Teo: None. D. Maron: None. S. Sedlis: None. W. Kostuk: None. J. Spertus: None. M. Dada: None. B. Chaitman: None. G. Mancini: None. W. Weintraub: None.
- © 2014 by American Heart Association, Inc.