Low BP associated with increased risk for stroke, MI

Researchers found a J-curve relationship between CV events and BP at above and below reference levels.

Patients with coronary artery disease who also have low blood pressure are at higher risk for stroke and MI, data results from the American Society of Hypertension show.

Researchers examining results from the TNT study analyzed 10,001 patients with coronary artery disease. Patients were assigned to either 10 mg of atorvastatin daily (n=5,006) or 80 mg atorvastatin daily (n=4,995). The primary endpoint was a composite of death from coronary disease, nonfatal MI, resuscitation following cardiac arrest and fatal or nonfatal stroke.

Among the 10,001 patients, 982 (9.82%) reached the primary endpoint during the 4.9 follow-up period. The researchers reported a J-curve relationship between systolic or diastolic BPs both above and below reference BP ranges (130 to 140 mm Hg for systolic, 70 to 80 mm Hg for diastolic) and major CV events, despite a reduction in LDL levels. According to the study results, there was a 3.1-fold increase in the risk for major CV events in patients with a systolic BP of =110 mm Hg and a 3.3-fold increased risk in the group with a diastolic BP =60 mm Hg. Following application of a nonlinear Cox model, a BP of 140.6 mm Hg for systolic and 79.8 mm Hg for diastolic were associated with the lowest event rates.

“There is no question that a lot of patients are not controlled at present, but the dictum that lower is better is not true in all patients and particularly not true in patients with manifest CAD,” Franz Messerli, MD, director of the hypertension program at Saint Luke’s-Roosevelt Hospital in New York and a member of the Cardiology Today Editorial Board, said in an interview. “In patients with coronary artery disease, you really have to be careful.” – by Eric Raible

For more information:

Messerli F. P-177. Presented at: American Society of Hypertension 24th Annual Scientific Meeting; May 6-9, 2009; San Francisco.