Blood pressure and mortality after percutaneous coronary intervention: a population-based cohort study

Chung-Woo Lee,Do Hoon Kim,Joo-Hyun Park,Joo Kyung Lee,Hyunjin Kim,Kyungdo Han,Yeon Joo Choi,Jin-Hyung Jung

doi:10.1038/s41598-022-06627-4

Abstract

Revascularization procedures, including percutaneous coronary intervention (PCI), for coronary artery disease (CAD) are increasingly performed in Korea. However, studies on blood pressure control targets in these patients remain insufficient. To assess the relationship between baseline blood pressure and all-cause mortality in CAD patients who underwent PCI. A population-based retrospective cohort study based on the national claims database of the Korean National Health Insurance System, which represents the entire Korean population. A total 38,330 patients with a history of PCI for CAD between 2005 and 2008 were recruited and followed up for all-cause mortality until December 31, 2017. Baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and they were classified into eight SBP and DBP groups each. The hazard ratios (HRs) for all-cause mortality were measured for each group. The pattern of SBP and DBP in this population followed a J-curve relationship for all-cause mortality, with the nadir point at 119 and 74 mmHg, respectively. In subjects aged > 60 years, high SBP (≥ 160 mmHg) and high DBP (≥ 90 mmHg) were significantly related to death. Moreover, in subjects aged > 60 years, low DBP (< 70 mmHg) was significantly related to mortality. There is a J-curve relationship between baseline blood pressure and all-cause mortality in patients who underwent PCI, and intensive lowering of blood pressure may be beneficial for these patients. However, the elderly population needs more attention as excessive BP lowering, particularly DBP, could instead increase the risk of death.

Highlights

Revascularization procedures, including percutaneous coronary intervention (PCI), for coronary artery disease (CAD) are increasingly performed in Korea
In this study of Korean subjects who underwent PCI for CAD, it was found that the relationship between blood pressure (BP) and all-cause mortality follows a J-shaped relationship in terms of both systolic blood pressure (SBP) and diastolic blood pressure (DBP)
This study suggests that intensive BP lowering is effective in this patient population, but it is necessary to appropriately control BP especially when considering age, because of the high risk of mortality from excessive BP lowering

Summary

Introduction

Revascularization procedures, including percutaneous coronary intervention (PCI), for coronary artery disease (CAD) are increasingly performed in Korea. Abbreviations BMI Body mass index BP Blood pressure CAD Coronary artery disease CI Confidence interval DBP Diastolic blood pressure HR Hazard ratio ICD-10 International Classification of Disease 10th revision INVEST INternational VErapamil SR-trandolapril Study MI Myocardial infarction NHIS National Health Insurance System PCI Percutaneous coronary intervention PROVE IT-TIMI PRavastatin Or atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction naver.com. The ideal BP target in patients with a CAD history remains controversial, with the recent emergence of the new breakthrough hypothesis about the existence of a J-curve relationship between the degree of blood pressure (BP) control and its outcomes[3]. This study aimed to identify the best BP targets in this population by investigating the relationship between the degree of BP control and all-cause mortality in patients who underwent PCI for CAD. We analyzed the relationship between baseline BP level and death of patients who underwent PCI by using the Korean National Health Insurance System (NHIS) database

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Conclusion