Author + information
- Brian Bergmark,
- Deepak Bhatt,
- Philippe Steg,
- Christina Fanola,
- Ofri Mosenzon,
- Itamar Raz,
- Eugene Braunwald and
- Benjamin Scirica
Background: The optimal blood pressure for prevention of cardiovascular (CV) events in patients with diabetes remains uncertain. There is additional concern for increased risk with low diastolic blood pressure (DBP).
Methods: CV outcomes were compared in 16,485 patients enrolled in SAVOR-TIMI 53 stratified by baseline SBP and DBP. Adjusted risk was calculated in patients with coronary artery disease (CAD) by DBP stratum as well as continuous DBP. Further sensitivity analyses were performed with stratification by SBP. Troponin concentration at baseline was analyzed by DBP stratum.
Results: Adjusted risk of composite MACE end point of CV death, MI, or ischemic stroke showed a J-shaped relationship with baseline SBP and DBP, with lowest risk at SBP 130-140 or DBP 80-90 mmHg (Fig 1A). In patients with CAD (n=10,274), DBP < 60 mmHg was associated with increased MACE (HRadj 1.38 [1.02-1.87]), MI (HRadj 1.82 [1.21-2.73]), and all-cause mortality (ACM) (HRadj 1.71 [1.27-2.68]). J-shaped relationships were seen for these end points in all SBP strata. Risk of ischemic stroke, conversely, decreased with lower DBP in patients with CAD, with a rate of 0.8% for DBP < 60 and 3.1% for DBP > 90 mmHg (p=0.021) (Fig 1B). Troponin concentration showed a J-shaped relationship with DBP in patients with CAD (Fig 1B).
Conclusions: In patients with diabetes and elevated CV risk, there is a J-shaped relationship between MACE and baseline blood pressure as well as increased subclinical myocardial injury, MI, and ACM in patients with CAD and low DBP.
Room 147 A
Sunday, March 19, 2017, 8:25 a.m.-8:35 a.m.
Session Title: Highlighted Original Research: Prevention and the Year in Review
Abstract Category: 33. Prevention: Hypertension
Presentation Number: 911-06
- 2017 American College of Cardiology Foundation