title: Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study.
abstract: The optimum blood pressure target in hypertension remains debated, especially in coronary artery disease, given concerns for reduced myocardial perfusion if diastolic blood pressure is too low. We aimed to study the association between achieved blood pressure and cardiovascular outcomes in patients with coronary artery disease and hypertension.
  
  
  
  We analysed data from 22 672 patients with stable coronary artery disease enrolled (from Nov 26, 2009, to June 30, 2010) in the CLARIFY registry (including patients from 45 countries) and treated for hypertension. Systolic and diastolic blood pressures before each event were averaged and categorised into 10 mm Hg increments. The primary outcome was the composite of cardiovascular death, myocardial infarction, or stroke. Hazard ratios (HRs) were estimated with multivariable adjusted Cox proportional hazards models, using the 120-129 mm Hg systolic blood pressure and 70-79 mm Hg diastolic blood pressure subgroups as reference.
  
  
  
  After a median follow-up of 5·0 years, increased systolic blood pressure of 140 mm Hg or more and diastolic blood pressure of 80 mm Hg or more were each associated with increased risk of cardiovascular events. Systolic blood pressure of less than 120 mm Hg was also associated with increased risk for the primary outcome (adjusted HR 1·56, 95% CI 1·36-1·81). Likewise, diastolic blood pressure of less than 70 mm Hg was associated with an increase in the primary outcome (adjusted HR 1·41 [1·24-1·61] for diastolic blood pressure of 60-69 mm Hg and 2·01 [1·50-2·70] for diastolic blood pressure of less than 60 mm Hg).
  
  
  
  In patients with hypertension and coronary artery disease from routine clinical practice, systolic blood pressure of less than 120 mm Hg and diastolic blood pressure of less than 70 mm Hg were each associated with adverse cardiovascular outcomes, including mortality, supporting the existence of a J-curve phenomenon. This finding suggests that caution should be taken in the use of blood pressure-lowering treatment in patients with coronary artery disease.
  
  
  
  Servier.
authors: Cardiology and Physiology Departments, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; Inserm U1149, Paris, France.
authors: Emmanuelle
authors: E
authors: Vidal-Petiot
authors: University of Glasgow, Glasgow, UK.
authors: Ian
authors: I
authors: Ford
authors: University of Glasgow, Glasgow, UK.
authors: Nicola
authors: N
authors: Greenlaw
authors: Maria Cecilia Hospital, GVM Care & Research, ES Health Science Foundation, Cotignola, Italy; Department of Cardiology and LTTA Centre, University of Ferrara, Cotignola, Italy.
authors: Roberto
authors: R
authors: Ferrari
authors: National Heart and Lung Institute, Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London, UK.
authors: Kim M
authors: KM
authors: Fox
authors: Montreal Heart Institute, Université de Montreal, Montreal, Canada.
authors: Jean-Claude
authors: JC
authors: Tardif
authors: Medical University of Silesia, Katowice, Poland.
authors: Michal
authors: M
authors: Tendera
authors: Maria Cecilia Hospital, GVM Care & Research, ES Health Science Foundation, Cotignola, Italy.
authors: Luigi
authors: L
authors: Tavazzi
authors: Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA.
authors: Deepak L
authors: DL
authors: Bhatt
authors: Cardiology and Physiology Departments, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National Heart and Lung Institute, Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London, UK; French Alliance for Cardiovascular Trials, an F-CRIN network, INSERM U1148, Paris, France. Electronic address: gabriel.steg@aphp.fr.
authors: Philippe Gabriel
authors: PG
authors: Steg
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007022:Hypotension / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D020521:Stroke; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents