Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study
Abstract
:1. Introduction
2. Methods
2.1. Inclusion Criteria
2.2. Study Design
2.3. Follow-up
2.4. Data Collection
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Appendix A
References
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Clinical Characteristics | <130 mm Hg | 130–140 mm Hg | >140 mm Hg |
---|---|---|---|
Patients, n | 1664 | 1302 | 1823 |
Clinical characteristics | |||
Mean age (years) | 63 ± 13 | 67 ± 11 ‡ | 69 ± 10 ‡ |
Gender (male) | 1306 (78%) | 965 (74%) † | 1291 (71%) ‡ |
Body mass index (Kg/m2) | 27 ± 4.4 | 28 ± 4.2 ‡ | 29 ± 4.5 ‡ |
Underlying diseases | |||
Cancer | 79 (4.7%) | 71 (5.5%) | 122 (6.7%) * |
Diabetes | 552 (33%) | 523 (40%) ‡ | 799 (44%) ‡ |
Current smokers | 318 (19%) | 326 (25%) ‡ | 394 (22%) |
Chronic lung disease | 254 (15%) | 181 (14%) | 251 (14%) |
Chronic heart disease | 164 (9.9%) | 88 (6.8%) † | 134 (7.4%) † |
Clinical presentation | |||
Coronary artery disease | 900 (54%) | 442 (34%) ‡ | 380 (21%) ‡ |
Cerebrovascular disease | 364 (22%) | 439 (34%) ‡ | 580 (32%) ‡ |
Peripheral artery disease | 400 (24%) | 421 (32%) ‡ | 863 (47%) ‡ |
Physical examination | |||
Sinus rhythm | 1474 (89%) | 1203 (92%) ‡ | 1667 (91%) † |
Mean SBP levels (mm Hg) | 119 ± 8.0 | 135 ± 3.1 ‡ | 153 ± 10.4 ‡ |
Number of SBP measurements | 8487 | 6229 | 8792 |
Mean (SD) of SBP measurements | 5.1 ± 3.3 | 4.8 ± 2.5 † | 4.8 ± 2.5 † |
Median (IQR) of SBP measurements | 4 (3–5) | 4 (3–5) | 4 (3–6) |
Laboratory levels | |||
Creatinine Clearance (mL/min) | 80 ± 33 | 77 ± 29 † | 72 ± 29 ‡ |
Total cholesterol (mg/100 mL) | 170 ± 35 | 177 ± 35 ‡ | 180 ± 37 ‡ |
LDL-cholesterol (mg/100 mL) | 100 ± 30 | 104 ± 31 ‡ | 105 ± 32 ‡ |
Drugs | |||
Diuretics | 513 (31%) | 464 (36%) † | 931 (51%) ‡ |
Beta-blockers | 907 (55%) | 497 (38%) ‡ | 556 (30%) ‡ |
ACE-inhibitors | 762 (46%) | 536 (41%) * | 872 (48%) |
Angiotensin-II antagonists | 299 (18%) | 405 (31%) ‡ | 734 (40%) ‡ |
Calcium antagonists | 321 (19%) | 337 (26%) ‡ | 637 (35%) ‡ |
Antiplatelets | 1478 (89%) | 1185 (91%) | 1630 (89%) |
Anticoagulants | 281 (17%) | 176 (14%) * | 262 (14%) * |
Statins | 1394 (84%) | 1064 (82%) | 1458 (80%) † |
Insulin | 216 (13%) | 169 (13%) | 327 (18%) ‡ |
Oral antidiabetics | 382 (23%) | 415 (32%) ‡ | 611 (34%) ‡ |
Subsequent Events | <130 mm Hg | 130–140 mm Hg | >140 mm Hg | |||||
---|---|---|---|---|---|---|---|---|
n | 100 Patient-Years (95% CI) | n | 100 Patient-Years (95% CI) | Rate Ratio (95% CI) | n | 100 Patient-Years (95% CI) | Rate Ratio (95% CI) | |
CAD patients, n | 900 | 442 | 380 | |||||
Follow-up (years) | 1.406 | 0.574 | 0.486 | |||||
Myocardial infarction | 32 | 2.27 (1.55–3.21) | 18 | 3.13 (1.85–4.95) | 1.37 (75–2.44) | 27 | 5.55 (3.66–8.08) | 2.44 (1.45–4.08) ‡ |
Ischemic stroke | 2 | 0.14 (0.04–0.62) | 6 | 1.05 (0.38–2.27) | 7.34 (1.55–52.9) * | 9 | 1.86 (0.85–3.51) | 13.02 (3.10–88.41) ‡ |
Limb amputation | 3 | 0.21 (0.05–0.58) | 0 | - | - | 2 | 0.41 (0.46–1.48) | 1.92 (0.22–1.29) |
Death | 28 | 1.99 (1.32–2.87) | 23 | 4.01 (2.53–6.01) | 2.01 (1.14–3.50) * | 29 | 5.96 (3.99–8.57) | 2.99 (1.77–5.06) ‡ |
CVD patients, n | 364 | 439 | 580 | |||||
Follow-up (years) | 0.571 | 0.580 | 0.689 | |||||
Myocardial infarction | 4 | 0.71 (0.23–1.71) | 3 | 0.52 (0.13–1.42) | 0.73 (0.13–3.57) | 3 | 0.44 (0.11–1.19) | 0.62 (0.11–3.01) |
Ischemic stroke | 17 | 3.04 (1.83–4.76) | 10 | 1.75 (0.89–3.12) | 0.57 (0.25–1.26) | 35 | 5.20 (3.68–7.16) | 1.70 (0.96–3.11) |
Limb amputation | 2 | 0.35 (0.06–1.16) | 0 | - | - | 2 | 0.29 (0.05–0.96) | 0.82 (0.08–7.96) |
Death | 27 | 4.73 (3.18–6.79) | 13 | 2.24 (1.25–3.73) | 0.47 (0.23–0.91) * | 28 | 4.07 (2.75–5.80) | 0.85 (0.50–1.46) |
PAD patients, n | 400 | 421 | 863 | |||||
Follow-up (years) | 0.578 | 0.637 | 1.352 | |||||
Myocardial infarction | 17 | 2.98 (1.80–4.68) | 10 | 1.58 (0.80–2.81) | 0.53 (0.23–1.16) | 22 | 1.65 (1.06–2.45) | 0.55 (0.29–1.05) |
Ischemic stroke | 13 | 2.28 (1.27–3.79) | 11 | 1.74 (0.92–3.03) | 0.76 (0.33–1.73) | 22 | 1.65 (1.06–2.45) | 0.72 (0.36–1.47) |
Limb amputation | 23 | 3.97 (2.52–5.97) | 16 | 2.56 (1.52–4.07) | 0.63 (0.32–1.19) | 26 | 1.92 (1.25–2.81) | 0.48 (0.27–0.85) * |
Death | 47 | 8.13 (5.97–10.81) | 25 | 3.92 (2.53–5.79) | 0.48 (0.29–0.78) † | 40 | 2.95 (2.11–4.02) | 0.36 (0.23–0.55) ‡ |
Predictors | CAD Patients | CVD Patients | PAD Patients |
---|---|---|---|
Age > 65 years | 2.16 (1.17–4.01) * | - | - |
Chronic heart disease | - | 2.44 (1.13–5.28) * | - |
SBP < 130 mm Hg | Ref. | Ref. | Ref. * |
SBP 130–140 mm Hg | 1.06 (0.62–1.80) | 0.52 (0.25–1.10) | 0.71 (0.46–1.09) |
SBP >140 mm Hg | 1.39 (0.86–2.26) | 1.46 (0.84–2.54) | 0.57 (0.39–0.83) † |
CrCl levels < 60 mL/min | 2.19 (1.32–3.62) † | - | - |
Diuretics | 1.83 (1.14–2.93) * | - | - |
Beta-blockers | - | - | 1.46 (1.03–2.09) * |
Insulin | 2.38 (1.53–3.70) ‡ | - | 2.83 (2.02–3.98) ‡ |
Antiplatelets | - | 5.19 (1.94–13.9) † | - |
Anticoagulants | - | 2.57 (1.45–4.56) † | - |
Predictors | CAD Patients | CVD Patients | PAD Patients |
---|---|---|---|
Age > 65 years | 3.42 (1.49–7.87) † | 3.66 (1.53–8.76) † | 1.74 (1.05–2.87) * |
Cancer | 2.33 (1.19–4.59) * | - | - |
Chronic lung disease | 1.85 (1.10–3.11) * | - | - |
Chronic heart disease | 1.86 (1.11–3.10) * | - | - |
Sinus rhythm | - | 0.27 (0.17–0.45) ‡ | |
SBP < 130 mm Hg | Ref. | Ref. † | Ref. ‡ |
SBP 130–140 mm Hg | 1.28 (0.74–2.25) | 0.39 (0.20–0.77) † | 0.47 (0.29–0.78) † |
SBP >140 mm Hg | 1.46 (0.85–2.51) | 0.46 (0.26–0.84) * | 0.32 (0.21–0.50) ‡ |
CrCl levels < 60 mL/min | 1.88 (1.07–3.28) * | 1.90 (1.15–3.15) * | 2.09 (1.35–3.26) † |
Beta-blockers | - | - | 0.58 (0.35–0.98) * |
Diuretics | 1.98 (1.13–3.48) * | - | - |
Statins | 0.45 (0.27–0.75) † | 0.36 (0.22–0.59) ‡ | 0.39 (0.26–0.58) ‡ |
Insulin | - | 1.85 (1.01–3.37) * | - |
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Sánchez Muñoz-Torrero, J.F.; Escudero-Sánchez, G.; Calderón-García, J.F.; Rico-Martín, S.; Robles, N.R.; Bacaicoa, M.A.; Alcalá-Pedrajas, J.N.; Gil-Fernández, G.; Monreal, M.; on behalf of the FRENA Investigators. Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study. Int. J. Environ. Res. Public Health 2021, 18, 9348. https://doi.org/10.3390/ijerph18179348
Sánchez Muñoz-Torrero JF, Escudero-Sánchez G, Calderón-García JF, Rico-Martín S, Robles NR, Bacaicoa MA, Alcalá-Pedrajas JN, Gil-Fernández G, Monreal M, on behalf of the FRENA Investigators. Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study. International Journal of Environmental Research and Public Health. 2021; 18(17):9348. https://doi.org/10.3390/ijerph18179348
Chicago/Turabian StyleSánchez Muñoz-Torrero, Juan F., 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. 2021. "Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study" International Journal of Environmental Research and Public Health 18, no. 17: 9348. https://doi.org/10.3390/ijerph18179348