Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study

Juan F. Sánchez Muñoz-Torrero, Guillermo Escudero-Sánchez, Julián F. Calderón-García, Sergio Rico-Martín, Nicolás Roberto Robles, M. Asunción Bacaicoa, José N. Alcalá-Pedrajas, Guadalupe Gil-Fernández, Manuel Monreal and on behalf of the FRENA Investigators
Additional contact information
Juan F. Sánchez Muñoz-Torrero: Department of Internal Medicine, Hospital San Pedro Alcántara, 10003 Cáceres, Spain
Guillermo Escudero-Sánchez: Department of Internal Medicine, Hospital Virgen Del Puerto, Plasencia, 10003 Cáceres, Spain
Julián F. Calderón-García: Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain
Sergio Rico-Martín: Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain
Nicolás Roberto Robles: Department of Nephrology, Hospital Infanta Cristina, 06080 Badajoz, Spain
M. Asunción Bacaicoa: Centro de Salud Manuel Encinas, 10001 Cáceres, Spain
José N. Alcalá-Pedrajas: Department of Internal Medicine, Hospital Comarcal Valle de los Pedroches, 14400 Pozoblanco, Spain
Guadalupe Gil-Fernández: Department of Nursing, Faculty of Medicine, University of Extremadura, 06080 Badajoz, Spain
Manuel Monreal: Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, 08916 Barcelona, Spain
on behalf of the FRENA Investigators: A full list of the FRENA Investigators is given in the Appendix A.

IJERPH, 2021, vol. 18, issue 17, 1-11

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.

Keywords: systolic blood pressure; outcomes; symptomatic artery disease; ischemic event; death (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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