Could intensive anti-hypertensive therapy produce the “J-curve effect” in patients with coronary artery disease and hypertension after revascularization?

W. Lu

Cardiology Department, Xuzhou Central Hospital, Xuzhou, China. lzr357@163.com

---

• Cardiology

OBJECTIVE: Intervention and prospective long-term follow-up was performed to observe the presence of the “J-curve effect” in patients with Coronary Artery Disease (CAD) who underwent intensive anti-hypertensive therapy after (PCI or CABG).

PATIENTS AND METHODS: Four hundred and thirty-six successive CAD patients were included in this study, 67 patients with CAD only (Group A) and the 369 patients with both CAD and hypertension who were randomly assigned to Group B (no control of blood pressure (BP), n=72), Group C (n=83, target BP 130-140/80-90 mmHg), Group D (n=78, target BP 120-130/75-80 mmHg), Group E (n=74, target BP 110-120/70-75 mmHg) and Group F (n=62, target BP <110/70 mmHg). All patients had undergone revascularization and anti-hypertensive therapy. The composite endpoint was the end of the follow-up, i.e. major adverse cardiac events (MACE) (cardiac death, nonfatal myocardial infarction and target vessel revascularization) and stroke.

RESULTS: 1) Results showed that smoking, total cholesterol (Tc), low density lipoprotein-C (LDL-C), high-sensitivity C-reactive protein (hs-CRP), β-blockers, ACEI or ARB (except for Group A and Group B), diuretics and follow-up duration among the 6 groups were not significantly different, However significantly lower than those results on admission (p<0.05). The difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP) was significant, p<0.05, both BP achieved target values. 2) The “J-curve effect” was present in the actual occurrence of composite endpoint and MACE for SBP and DBP, with a reasonable BP-lowering range of 120-130/75-80 mmHg, while the “J-curve effect” was absent in the occurrence of stroke.

CONCLUSIONS: For the patients who had CAD and hypertension, intensive anti-hypertensive therapy could produce the “J-curve effect” after revascularization with the optimal blood pressure (BP) range being 120-130/75-80 mmHg.

Free PDF Download