Key result
One-year post-ACS systolic blood pressure showed a J-shaped association with MACE; lowest risk was at 130-140 mmHg, while each 5-mmHg increase above 140 mmHg raised risk (HR 1.08; 95% CI 1.00-1.17).
Why the study?
Evidence specific to the post-ACS setting regarding the prognostic value of systolic blood pressure measured 1 year after ACS remains limited.
Does the level of systolic blood pressure measured 1 year after acute coronary syndrome predict subsequent cardiovascular outcomes?
Cohort (n=2,074)
Yes
Does the level of systolic blood pressure measured 1 year after acute coronary syndrome predict subsequent cardiovascular outcomes?
In patients 1 year post-ACS, systolic blood pressure showed a J-shaped association with cardiovascular risk, with the lowest risk occurring at 130-140 mmHg, which challenges strict guideline recommendations for targets below 130 mmHg in this population.
AIMS: Current guidelines recommend targeting systolic blood pressure (SBP) below 130 mmHg in patients at high cardiovascular risk, including after acute coronary syndrome (ACS), although evidence specific to the post-ACS setting remains limited. We evaluated the prognostic value of SBP measured 1 year after ACS on subsequent cardiovascular outcomes. METHODS: The ELIPS cohort prospectively enrolled ACS patients across four Swiss tertiary-care centers (2009-2017). Patients alive at 1 year with available SBP measurements were included. The association between SBP at 1 year and 3-point major adverse cardiovascular events (MACE; cardiovascular death, non-fatal stroke/transient ischemic attack, or non-fatal myocardial infarction) was modeled using restricted cubic splines, adjusted for age, sex, renal function, cardiovascular risk factors, index-event type, coronary revascularization, cardiac rehabilitation, heart-failure history, and antihypertensive medication classes. RESULTS: Among 2,074 patients (age 63±12 years; 82% male; 53% STEMI), 229 MACE events occurred over a median follow-up of 4.0 years (2.7 per 100 patient-years). The SBP-MACE relationship was nonlinear and J-shaped (P-non-linearity=0.007), with lowest risk between ∼130 and 140 mmHg (formally estimated nadir 138 mmHg [95%CI 116-152]). Above 140 mmHg, each 5-mmHg increase was associated with a borderline increase in MACE risk (adjusted HR 1.08; 95%CI 1.00-1.17). The pattern was broadly consistent across sex, age and hypertension status, with a possible interaction with diabetes that could not be excluded (P-interaction=0.08). CONCLUSIONS: In this large, predominantly male, well-characterized post-ACS cohort, SBP measured 1 year after ACS showed a J-shaped association with cardiovascular risk, with lowest risk at 130-140 mmHg.
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Lu et al. (2026) conducted a cohort in Acute Coronary Syndrome (n=2,074). Systolic blood pressure ≥140 mmHg vs. Systolic blood pressure 130-140 mmHg was evaluated on 3-point major adverse cardiovascular events (cardiovascular death, non-fatal stroke/transient ischemic attack, or non-fatal myocardial infarction) (HR 1.08, 95% CI 1.00-1.17). One-year post-ACS systolic blood pressure showed a J-shaped association with MACE; lowest risk was at 130-140 mmHg, while each 5-mmHg increase above 140 mmHg raised risk (HR 1.08; 95% CI 1.00-1.17).
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