Blood pressure shows J-shaped relationship with death risk in post-PCI CAD patients

A recent Korea study has found a J-shaped relationship between mortality risk and blood pressure (BP) in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI).

“This study suggests that intensive BP lowering is effective in this patient population, but it is necessary to appropriately control BP especially when considering age, because of the high risk of mortality from excessive BP lowering,” the researchers said.

The population-based retrospective cohort analysis included 38,330 patients (mean age 62 years, 72.4 percent men) who had undergone PCI for CAD between 2005 and 2008. The outcome was all-cause mortality evaluated until December 31, 2017 and assessed according to baseline systolic (S) and diastolic (D) BP.

Compared with a reference SBP range of 100–109 mm Hg, the following measurements were associated with elevated risks of all-cause mortality: SPB <100 mm Hg (hazard ratio [HR], 1.26, 95 percent confidence interval [CI], 1.07–1.49), 150–159 mm Hg (HR, 1.15, 95 percent CI, 1.02–1.30), and ≥160 mm Hg (HR, 1.29, 95 percent CI, 1.15–1.46).

Similarly, DBP 90–110 mm Hg (HR, 1.19, 95 percent CI, 1.10–1.29), 100–109 mm Hg (HR, 1.18, 95 percent CI, 1.05–1.33), and ≥110 mm Hg (HR, 1.54, 95 percent CI, 1.24–1.90) were all associated with elevated all-cause mortality risk relative to the reference range of DBP 70–79 mm Hg.

Similar trends were reported for SBP and DBP when looking at the outcome of mortality events, follow-up duration, and death rate per 1,000 person-years.