TOPLINE:

More than one third of patients with coronary heart disease had blood pressure (BP) less than 120/70 mm Hg, which is below the target range recommended by current European guidelines. These patients were more likely to have a history of heart failure, impaired kidney function, and severe frailty than those with BP at target.

METHODOLOGY:

• In an observational cohort study, researchers analyzed data from the INTERASPIRE survey (March 2020 to May 2023) to determine how many patients with coronary heart disease had BP less than the targets recommended by European guidelines (target range, 120-129/70-79 mm Hg).
• They included 4548 adults younger than 80 years who had been hospitalized for acute or chronic coronary events in 14 countries, with follow-up interviews and examinations at a median of 1.05 years after their index hospitalization.
• Using an automated device, seated BP was measured twice after 5 minutes of rest and readings were averaged. Systolic BP < 120 mm Hg or diastolic BP < 70 mm Hg was classified as below target.
• Researchers evaluated the proportion of patients in each BP category. They compared relevant measures such as clinical characteristics, comorbidities, receipt of BP-lowering treatments, and 1-year rates of recurrent cardiovascular events across groups.

TAKEAWAY:

• Overall, 35.7% of patients had BP less than the target, 53.9% had BP more than the target, and 10.3% had BP within the target range.
• Patients with below-target BP vs at-target BP more often had a history of heart failure (13.6% vs 10.0%) and had lower estimated glomerular filtration rate (81.4 vs 85.0 mL/min/1.73 m²), lower scores for quality of life (2.43 vs 2.5), and higher rates of severe frailty (0.9% vs 0.0%; P < .05 for all).
• Most patients with below-target BP used a median of two BP-lowering medications, with no difference in the cumulative dose intensity compared with those with at-target BP.
• Rates of 1-year recurrent cardiovascular events were numerically highest in patients with below-target BP but did not differ significantly across categories.

IN PRACTICE:

“Routine de-escalation of therapies in this group, as implied by the 2023 ESH [European Society of Hypertension] recommendations, could potentially lead to a worsening of average BP control in the overall population of patients with CHD [coronary heart disease], while also depriving some patients (eg, those with left ventricular remodeling) of the additional beneficial effects of many commonly prescribed BP-lowering medications. In the absence of definitive evidence, it is our opinion that BP-lowering therapies should not be routinely de-escalated in asymptomatic patients with CHD presenting with below-target office BP readings,” the researchers wrote.

SOURCE:

The study was led by John P. McCormick at the University of Galway in Galway, Ireland. It was published online on March 26 in Heart.

LIMITATIONS:

The findings were not fully representative of the global CHD population and varied among countries. BP was measured only in the clinic and lacked out-of-office measurements. The study was observational, and the results could not prove causation.

DISCLOSURES:

The INTERASPIRE survey received research grants from Pfizer, Abbott, Novartis, Sanofi, and Viatris, and from the International Atherosclerosis Society and the European Atherosclerosis Society. Some authors reported receiving grants, consulting and/or advisory fees, honoraria, and travel or educational support and/or having equity interests from commercial entities, including funding agencies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.