Document Detail


Relation between blood pressure and vascular events and mortality in patients with manifest vascular disease: J-curve revisited.
MedLine Citation:
PMID:  22068865     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Johannes A N Dorresteijn; Yolanda van der Graaf; Wilko Spiering; Diederick E Grobbee; Michiel L Bots; Frank L J Visseren;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-11-07
Journal Detail:
Title:  Hypertension     Volume:  59     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-16     Completed Date:  2012-02-07     Revised Date:  2012-05-29    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  14-21     Citation Subset:  IM    
Affiliation:
Department of Vascular Medicine, University Medical Center Utrecht, UMCU Postbox F02.126, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure*
Brain Ischemia / mortality*
Female
Follow-Up Studies
Humans
Hypertension / mortality*,  therapy*
Incidence
Male
Middle Aged
Morbidity
Myocardial Infarction / mortality*
Nonlinear Dynamics
Practice Guidelines as Topic
Risk Factors
Stroke / mortality*
Investigator
Investigator/Affiliation:
A Algra / ; Y van der Graaf / ; D E Grobbee / ; G E H M Rutten / ; F L J Visseren / ; F L Moll / ; L J Kappelle / ; W P T M Mali / ; P A Doevendans / ; Rutger van Petersen / ; Harry Pijl /
Comments/Corrections
Comment In:
Hypertension. 2012 May;59(5):e45; author reply e46   [PMID:  22454478 ]
Hypertension. 2012 Jan;59(1):8-9   [PMID:  22068873 ]
Hypertension. 2012 Apr;59(4):e29; author reply e30   [PMID:  22311901 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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