Coronary artery disease: lower diastolic blood pressure tied to increased risk for angina

Takeaway

• In patients with chronic coronary artery disease, lower diastolic blood pressure (DBP) was associated with a significant risk for angina.

Why this matters

• These findings, if validated in larger prospective studies, suggest that clinicians should consider less aggressive blood pressure control in patients with chronic coronary artery disease and angina.

Study design

• This cross-sectional, observational APPEAR (Angina Prevalence and Provider Evaluation of Angina Relief) study included 1259 outpatients aged ≥18 years with coronary artery disease.
• Patients were divided into quartiles (Q) of DBP: Q1 (40-64 mmHg), Q2 (65-71 mmHg), Q3 (72-79 mmHg), Q4 (80-108 mm Hg).
• Funding: Gilead Sciences.

Key results

• Mean age, 71.1 years.
• 32.7% of patients had ≥1 episode of angina in the prior month and 79.7% had hypertension.
• Mean DBP was 72.3 mm Hg.
• 37.0% of patients in the lowest quartile Q1 reported having at least 1 episode of angina in the prior month vs 33.7%, 29.9% and 30.3% of patients in Q2, Q3 and Q4, respectively.
• DBP showed J-shaped relationship with angina (P=.017; P_nonlinearity=.027) even after sequential adjustment for demographic characteristics (P=.002), comorbidities (P=.002), heart rate (P=.002), antihypertensive antianginal medications (P=.002) and systolic blood pressure (P=.045).

Limitations

• Cross-sectional design.