Systolic Blood Pressure 130-140 mm Hg and Diastolic Blood Pressure 80-90 mm Hg Associated with Lowest Risk of Future Cardiovascular Events after Acute Coronary Syndrome

DynaMed Weekly Update - Volume 5, Issue 47

Blood pressure control is important for reducing risk of cardiovascular events, but the optimal blood pressure level in many clinical scenarios is unknown. To identify the blood pressure ranges associated with lowest cardiovascular risk in patients with prior acute coronary syndromes, researchers performed a post-hoc analysis of the PROVE IT-TIMI 22 trial. Patients were grouped by average blood pressure readings achieved during the trial. Average readings outside of the ranges of 130-140 mm Hg systolic and 80-90 mm Hg diastolic had an increased risk of future cardiovascular events (level 2 [mid-level] evidence). A total of 4,162 patients hospitalized for acute coronary syndrome receiving a statin were evaluated for the effect of blood pressure range on a composite outcome of all-cause mortality, myocardial infarction, unstable angina requiring rehospitalization, revascularization after 30 days, and stroke.

During a mean follow-up of 24 months, 24% of patients reached the composite outcome. Blood pressures outside of the range of 130-140 mm Hg systolic and 80-90 mm Hg diastolic were associated with an increased risk of the composite outcome. Compared to patients in these blood pressure ranges, patients with significantly elevated blood pressure (systolic > 160 mm Hg or diastolic > 100 mm Hg) had 3.7-4.9-fold increased risk. The risk was also elevated for patients with low blood pressure (? 100 mm Hg systolic, ? 60 mm Hg diastolic), with a 1.2-2.1-fold increased risk of the composite outcome. The blood pressure associated with lowest risk was 136/85 mm Hg (p < 0.0001). Similar findings were observed for a composite outcome of death due to coronary heart disease, nonfatal myocardial infarction or revascularization, and for individual outcomes of all-cause mortality, cardiovascular mortality, and nonfatal myocardial infarction (Circulation 2010 Nov 23;122(21):2142).

For more information, see the Acute coronary syndrome topic in DynaMed.