Key result
Low diastolic blood pressure (<70 mmHg) independently predicted cardiovascular death in revascularized CAD patients aged 65-74 years (HR 1.665), but DBP <60 mmHg was not an independent predictor in those aged ≥75 years.
Why the study?
Does low diastolic blood pressure increase the risk of cardiovascular death in elderly patients with coronary artery disease after revascularization?
Cohort (n=7,180)
Yes
Does low diastolic blood pressure increase the risk of cardiovascular death in elderly patients with coronary artery disease after revascularization?
Low diastolic blood pressure (<70 mmHg) is an independent predictor of cardiovascular death in Young-Old (65-74 years) but not Old-Old (≥75 years) patients with coronary artery disease after revascularization.
May warrant age-stratified DBP caution post-revascularization in 65-74 year-olds; leaves open optimal targets in those ≥75.
BACKGROUND: We investigated the effects of age and low diastolic blood pressure (DBP) on cardiovascular death in patients with coronary artery disease (CAD) after coronary revascularization. METHODS AND RESULTS: Stable, chronic CAD patients after coronary revascularization in the CREDO-Kyoto registry cohort-1 were allocated to the Young (≤64 years, n=2,619), Young-Old (65-74 years, n=2,932), and Old-Old (≥75 years, n=1,629) groups. Kaplan-Meier analysis showed that the crude cumulative incidence of cardiovascular death was higher in Young-Old patients with DBP <70 mmHg (P<0.001) and in Old-Old patients with DBP <60 mmHg (P=0.017), but not <70 mmHg (P=0.629), compared with each counterpart. Low DBP did not increase cardiovascular death in young patients. After adjustments with independent predictors, DBP <60 mmHg did not increase the cardiovascular death in the Old-Old group (HR=1.579 [95% CI, 0.944-2.642], P=0.082) and DBP <70 mmHg remained a predictor in the Young-Old group (HR=1.665 [1.094-2.532], P=0.017). On multivariate stepwise Cox proportional hazard regression analysis, independent predictors for cardiovascular death in low DBP patients were creatinine clearance (CCr; inversely), prior cerebrovascular disease, and aortic disease in the Young-Old group and CCr (inversely) and malignancy in the Old-Old group. CONCLUSIONS: DBP <60 mmHg was not an independent factor for predicting cardiovascular death in Old-Old revascularized CAD patients, whereas DBP <70 mmHg remained a predictor in the Young-Old. (Circ J 2016; 80: 1232-1241).
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Kai et al. (2016) conducted a cohort in Coronary artery disease after revascularization (n=7,180). Low diastolic blood pressure (<70 mmHg or <60 mmHg) vs. Diastolic blood pressure ≥70 mmHg or ≥60 mmHg was evaluated on Cardiovascular death (HR 1.665, 95% CI 1.094-2.532, p=0.017). Low diastolic blood pressure (<70 mmHg) independently predicted cardiovascular death in revascularized CAD patients aged 65-74 years (HR 1.665), but DBP <60 mmHg was not an independent predictor in those aged ≥75 years.
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