Relation Between Blood Pressure and Vascular Events and Mortality in Patients With Manifest Vascular Disease J-Curve Revisited

被引:115
作者
Dorresteijn, Johannes A. N. [1 ]
van der Graaf, Yolanda [2 ]
Spiering, Wilko [1 ]
Grobbee, Diederick E. [2 ]
Bots, Michiel L. [2 ]
Visseren, Frank L. J. [1 ]
机构
[1] Univ Med Ctr Utrecht, Dept Vasc Med, NL-3508 GA Utrecht, Netherlands
[2] Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands
关键词
hypertension; blood pressure; J-curve; vascular disease; secondary prevention; CARDIOVASCULAR EVENTS; HYPERTENSIVE PATIENTS; MYOCARDIAL-INFARCTION; HEART-DISEASE; PREVENTION; METAANALYSIS; RISK;
D O I
10.1161/HYPERTENSIONAHA.111.179143
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Recent studies have challenged the notion that "lower is better" for blood pressure in relation to vascular events and mortality in patients with vascular disease, whereas practice guidelines currently recommend to lower blood pressure to < 130/80 mm Hg. We reassessed this J-curved relationship between blood pressure and cardiovascular events and all-cause mortality in patients with various manifestations of vascular disease. For this purpose, 5788 patients with symptomatic vascular disease enrolled in the Secondary Manifestations of Arterial Disease Study were followed-up for the occurrence of new vascular events (ie, myocardial infarction, stroke, or vascular death) and all-cause mortality. During a median of 5.0 years (interquartile range: 2.6-8.1 years), 788 patients experienced a new vascular event, and 779 died. Overall, the covariate-adjusted relationship between mean baseline systolic, diastolic, or pulse pressure and the occurrence of vascular events followed a J-curve with increased event rates above and below the nadir blood pressure of 143/82 mm Hg. A similar nonlinear relationship was found for diastolic pressure and all-cause mortality. Elevated blood pressure was not associated with increased morbidity and mortality in patients with recently diagnosed coronary artery disease, >= 65 years, and having > 60 mm Hg pulse pressure. Importantly, especially in these subgroups, low blood pressure could also be a symptom rather than a cause of disease. Blood pressure level below and above 143/82 mm Hg is, thus, an independent risk factor for recurrent events in patients with manifest vascular disease. Uncertainty of whether this association is causal provides a strong rationale for trials evaluating blood pressure treatment targets. (Hypertension. 2012; 59: 14-21.). Online Data Supplement
引用
收藏
页码:14 / U59
页数:19
相关论文
共 24 条
[21]   Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study [J].
Sleight, Peter ;
Redon, Josep ;
Verdecchia, Paolo ;
Mancia, Giuseppe ;
Gao, Peggy ;
Fagard, Robert ;
Schumacher, Helmut ;
Weber, Michael ;
Boehm, Michael ;
Williams, Bryan ;
Pogue, Janice ;
Koon, Teo ;
Yusuf, Salim .
JOURNAL OF HYPERTENSION, 2009, 27 (07) :1360-1369
[22]   Antihypertensive Treatment and Secondary Prevention of Cardiovascular Disease Events Among Persons Without Hypertension A Meta-analysis [J].
Thompson, Angela M. ;
Hu, Tian ;
Eshelbrenner, Carrie L. ;
Reynolds, Kristi ;
He, Jiang ;
Bazzano, Lydia A. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2011, 305 (09) :913-922
[23]  
Turnbull F, 2005, ARCH INTERN MED, V165, P1410
[24]   J-SHAPED RELATION BETWEEN CHANGE IN DIASTOLIC BLOOD-PRESSURE AND PROGRESSION OF AORTIC ATHEROSCLEROSIS [J].
WITTEMAN, JCM ;
GROBBEE, DE ;
VALKENBURG, HA ;
VANHEMERT, AM ;
STIJNEN, T ;
BURGER, H ;
HOFMAN, A .
LANCET, 1994, 343 (8896) :504-507