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June 1, 1990Journal of Hypertension

The J-shaped relationship between coronary heart disease and achieved blood pressure level in treated hypertension: further analyses of 12 years of follow-up of treated hypertensives in the Primary Prevention Trial in Gothenburg, Sweden

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Key result

Achieved blood pressure levels during antihypertensive treatment showed a J-shaped relationship with coronary heart disease incidence, with the lowest risk observed at approximately 150/85 mmHg.

Why the study?

Does the achieved blood pressure level during antihypertensive treatment affect the incidence of coronary heart disease in middle-aged hypertensive men?

Population

686 middle-aged hypertensive men from a random population sample in Gothenburg, Sweden

Design

Cohort

Follow-up

12 years

Authors

OSOla SamuelssonGeneral / Preventive / LipidsLWLars W. WilhelmsenMalmö UniversityKPKjel M. Pennert

Discussion

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Implication

Supports caution with intensive lowering in treated hypertensives; hypothesis-generating for optimal targets in randomized trials.

Key Points

  • This research aims to investigate how different achieved blood pressure levels influence the incidence of coronary heart disease in treated hypertensive patients.
  • Followed 686 middle-aged hypertensive men over 12 years, totaling 6563 patient-years.
  • Analyzed the relationship using Cox regression to identify the effects of systolic and diastolic blood pressure on coronary heart disease incidence.
  • Explored associations while adjusting for factors like age, cholesterol, blood pressure, and smoking habits.
  • 87 patients experienced non-fatal myocardial infarction or CHD-related death during follow-up.
  • CHD incidence revealed a J-shaped curve concerning blood pressure levels, decreasing to about 150/85 mmHg before increasing again.
  • The nadir of the incidence occurred at a diastolic blood pressure of 81 mmHg, indicating potential harm from excessively low blood pressure.

Study Design

Type

Cohort (n=686)

Multicenter

No

Structured PICO

Does the achieved blood pressure level during antihypertensive treatment affect the incidence of coronary heart disease in middle-aged hypertensive men?

P
Population
686 middle-aged hypertensive men from a random population sample in Gothenburg, Sweden
I
Intervention
Antihypertensive treatment (analysis of achieved blood pressure levels)
O
Outcome
Incidence of coronary heart disease (CHD), defined as non-fatal myocardial infarction or death from CHDhard clinical

In treated hypertensive men, there is a J-shaped relationship between achieved blood pressure and CHD incidence, suggesting that excessive blood pressure lowering may increase cardiovascular risk.

Limitations

  • Cannot exclude the possibility that the increased incidence of CHD in patients with a low treated blood pressure is due primarily to pre-existing but subclinical ischemic heart disease.
  • Cannot exclude the possibility that the increased incidence of CHD in patients with a low treated blood pressure is due primarily to pre-existing but subclinical ischemic heart disease

Cite This Study

Samuelsson et al. (1990) conducted a cohort in Treated hypertension (n=686). Achieved blood pressure level through antihypertensive treatment vs. Different achieved blood pressure levels was evaluated on Incidence of coronary heart disease (non-fatal myocardial infarction or death from CHD). Achieved blood pressure levels during antihypertensive treatment showed a J-shaped relationship with coronary heart disease incidence, with the lowest risk observed at approximately 150/85 mmHg.

synapsesocial.com/papers/6a07b4da44ff8ad339f69c53https://doi.org/10.1097/00004872-199006000-00008

Topics

Hypertension managementCardiovascular prevention
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