Abstract
Objectives: The most appropriate targets for systolic blood pressure (SBP) levels to reduce cardiovascular morbidity and mortality in patients with symptomatic artery disease remain controversial. We compared the rate of subsequent ischemic events or death according to mean SBP levels during follow-up. Design: Prospective cohort study. FRENA is an ongoing registry of stable outpatients with symptomatic coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD). Setting: 24 Spanish hospitals. Participants: 4789 stable outpatients with vascular disease. Results: As of June 2017, 4789 patients had been enrolled in different Spanish centres. Of these, 1722 (36%) had CAD, 1383 (29%) CVD and 1684 (35%) PAD. Over a mean follow-up of 18 months, 136 patients suffered subsequent myocardial infarction, 125 had ischemic stroke, 74 underwent limb amputation, and 260 died. On multivariable analysis, CVD patients with mean SBP levels 130–140 mm Hg had a lower risk of mortality than those with levels <130 mm Hg (hazard ratio (HR): 0.39; 95% CI: 0.20–0.77), as did those with levels >140 mm Hg (HR: 0.46; 95% CI: 0.26–0.84). PAD patients with mean SBP levels >140 mm Hg had a lower risk for subsequent ischemic events (HR: 0.57; 95% CI: 0.39–0.83) and those with levels 130–140 mm Hg (HR: 0.47; 95% CI: 0.29–0.78) or >140 mm Hg (HR: 0.32; 95% CI: 0.21–0.50) had a lower risk of mortality. We found no differences in patients with CAD. Conclusions: In this real-world cohort of symptomatic arterial disease patients, most of whom are not eligible for clinical trials, the risk of subsequent events and death varies according to the levels of SBP and the location of previous events. Especially among patients with large artery atherosclerosis, PAD or CVD, SBP <130 mm Hg may result in increased mortality. Due to potential factors in this issue, Prospective, well designed studies are warranted to confirm these observational data.
Highlights
Patients with symptomatic artery disease are at increased risk for subsequent ischemic events, and could likely benefit from adequate control of risk factors for atherosclerosis, including hypertension
Hospitals participating in the FRENA registry prospectively recruited consecutive outpatients with medical history-based symptomatic artery disease with at minimum one recent episode of peripheral artery disease (PAD) (either intermittent claudication with an ankle-brachial index (ABI) < 0.9, previous vascular intervention or limb amputation for PAD); CVD; or coronary disease (CAD)
systolic blood pressure (SBP) levels >140 mm Hg had half the risk for subsequent ischemic events (HR: 0.57; 95% confidence intervals (CI): 0.39–0.83) and those with levels 130–140 mm Hg (HR: 0.47; 95% CI: 0.29–0.78) or >140 mm
Summary
Patients with symptomatic artery disease are at increased risk for subsequent ischemic events, and could likely benefit from adequate control of risk factors for atherosclerosis, including hypertension. Few studies have been designed to identify the optimal SBP levels after an arterial ischemic event, and most were performed in patients with either cerebrovascular (CVD) or coronary disease (CAD) [3,4,5,6,7,8,9,10,11]. There are scarce data from patients with peripheral artery disease (PAD) [12,13]. The FRENA (Factores de Riesgo y Enfermedad Arterial) registry is a longitudinal, observational and multicenter registry to collect and analyse clinical data, treatment patterns and outcomes in stable outpatients with PAD, CVD or CAD from Spanish hospitals. The FRENA (Factores de Riesgo y Enfermedad Arterial) registry is a longitudinal, observational and multicenter registry to collect and analyse clinical data, treatment patterns and outcomes in stable outpatients with PAD, CVD or CAD from Spanish hospitals. [14,15,16,17,18,19].
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