Author + information
- Received February 10, 2018
- Revision received April 23, 2018
- Accepted May 4, 2018
- Published online September 3, 2018.
- Poghni A. Peri-Okonny, MDa,b,∗ (, )@saintlukeskc@UMKansasCity,
- Krishna K. Patel, MDa,b,
- Philip G. Jones, MSa,b,
- Tracie Breeding, RNa,
- Kensey L. Gosch, MSa,
- John A. Spertus, MD, MPHa,b and
- Suzanne V. Arnold, MD, MHAa,b
- aSaint Luke’s Mid America Heart Institute, Kansas City, Missouri
- bUniversity of Missouri–Kansas City, Kansas City, Missouri
- ↵∗Address for correspondence:
Dr. Poghni A. Peri-Okonny, Department of Cardiovascular Medicine, Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th Floor, Kansas City, Missouri 64111.
Background In patients with coronary artery disease (CAD), low diastolic blood pressure (DBP) is associated with increased risk of myocardial infarction, but its association with angina is unknown.
Objectives The goal of this study was to examine the association of low DBP and angina in patients with CAD.
Methods The study assessed the frequency of angina (measured by using the Seattle Angina Questionnaire–Angina Frequency score) according to DBP in patients with known CAD from 25 U.S. cardiology clinics. Hierarchical logistic regression was used to test the association between DBP and angina, with a spline term for DBP to assess nonlinearity.
Results Among 1,259 outpatients with CAD, 411 (33%) reported angina in the prior month, with higher rates in the lowest DBP quartile (40 to 64 mm Hg: 37%). In the unadjusted model, DBP was associated with angina with a J-shaped relationship (p = 0.017, p for nonlinearity = 0.027), with a progressive increase in odds of angina as DBP decreased below ∼70 to 80 mm Hg. This association remained significant after sequential adjustment for demographic characteristics (p = 0.002), comorbidities (p = 0.002), heart rate (p = 0.002), systolic blood pressure (p = 0.046), and antihypertensive antianginal medications (p = 0.045).
Conclusions In patients with chronic CAD, there seemed to be an association between lower DBP and increased odds of angina. If validated, these findings suggest that clinicians should consider less aggressive blood pressure control in patients with CAD and angina.
The APPEAR (Angina Prevalence and Provider Evaluation of Angina Relief) study was supported by an investigator-initiated grant from Gilead Sciences. All data collection, data analyses, preparation of the manuscript, and the decision to submit the manuscript for publication were done independently of the study sponsor. Drs. Peri-Okonny and Patel were supported by a T32 training grant from the National Heart, Lung, and Blood Institute (T32HL110837). Dr. Spertus has received research grants from the National Heart, Lung, and Blood Institute, Patient-Centered Outcomes Research Institute, American College of Cardiology Foundation, and Abbott Vascular; has received consultant honoraria from United Healthcare, Bayer, Novartis, Janssen, V-Wave, and Corvia; and holds the copyright for the Seattle Angina Questionnaire. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 10, 2018.
- Revision received April 23, 2018.
- Accepted May 4, 2018.
- 2018 American College of Cardiology Foundation
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