Optimal or standard control of systolic and diastolic blood pressure across risk factor categories in patients with chronic coronary syndromes

Vidal-Petiot, E., Elbez, Y., Mesnier, J., Ducrocq, G., Ford, I. , Tendera, M., Ferrari, R., Tardif, J.-C., Fox, K. M. and Steg, P. G. (2023) Optimal or standard control of systolic and diastolic blood pressure across risk factor categories in patients with chronic coronary syndromes. European Journal of Preventive Cardiology, 30(10), pp. 935-947. (doi: 10.1093/eurjpc/zwad004) (PMID:36617264)

Abstract

Aims: Guidelines have lowered blood pressure (BP) targets to <130/80 mmHg. We examined the benefit of intensive control for each BP component, versus the burden of other modifiable risk factors, in patients with chronic coronary syndromes (CCS). Methods and results: The CLARIFY registry (ISRCTN43070564) enrolled 32 703 CCS patients, from 2009−2010, with a 5-year follow-up. Patients with either BP component below European guideline safety boundaries (120/70 mmHg) were excluded, leaving 19 167 patients (mean age 63.8 ± 10.1 years, 78% men) in the present analysis. A multivariable-adjusted Cox proportional hazards model showed a gradual increase in cardiovascular risk (cardiovascular death, myocardial infarction, or stroke) when the number of uncontrolled risk factors (active smoking, no physical activity, low-density lipoprotein cholesterol ≥100 mg/dL, and diabetes with glycated haemoglobin ≥7%) increased [adjusted hazard ratio (HR): 1.34; 95% confidence interval (CI): 1.17−1.52, 1.65 (1.40−1.94), and 2.47 (1.90−3.21) for 1, 2, and 3 or 4 uncontrolled risk factors, respectively, versus 0], without significant interaction with BP. Although uncontrolled systolic (≥140 mmHg) and diastolic (≥90 mmHg) BP were both associated with higher risk than standard BP, standard BP was associated with higher risk than optimal control for only the diastolic component (adjusted HR: 1.08; 95% CI: 0.94−1.25 for systolic BP 130−139 versus 120−129 mmHg and 1.43; 95% CI: 1.27−1.62 for diastolic BP 80−89 versus 70−79 mmHg). Conclusions: Our results suggest that optimal BP target in CCS may be ≤139/79 mmHg, and that optimizing the burden of other risk factors should be prioritized over further reduction of systolic BP.

• Item Type: Articles
• Additional Information: The CLARIFY registry was supported by Servier.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ford, Professor Ian
• Authors: Vidal-Petiot, E., Elbez, Y., Mesnier, J., Ducrocq, G., Ford, I., Tendera, M., Ferrari, R., Tardif, J.-C., Fox, K. M., and Steg, P. G.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Journal of Preventive Cardiology
• Publisher: Oxford University Press
• ISSN: 2047-4873
• ISSN (Online): 2047-4881
• Published Online: 07 January 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in European Journal of Preventive Cardiology 30(10):935-947
• Publisher Policy: Reproduced under a Creative Commons License