Abstract
BACKGROUND: Recent guideline from the United States has a positive recommendation on lowering blood pressure (BP) target for patients with hypertension. However, excessively lowering BP might result in a possible deterioration of myocardial ischemia-reperfusion injury, especially in patients with coronary heart disease (CHD). OBJECTIVE: We aimed to assess the impact of lowering BP on the risk for adverse clinical outcomes among CHD patients who have undergone percutaneous coronary intervention (PCI). METHODS: A total of 1670 consecutive patients with CHD from the Dryad database who have undergone PCI were enrolled in our study. The primary outcomes were defined as adverse clinical events, all-cause death and cardiac death at the follow-up for a median of 29.8 months. RESULTS: Among these patients, the rate of major clinical events in these CHD patients was 191 (11.4%). The all-cause death and cardiac death of these patients with clinical events was 120 (62.8%) and 80 (41.9%), respectively. A smooth curve from a real world showed a U-shaped correlation between systolic BP and the rate of primary outcomes including major clinical events, all-cause death and cardiac death, respectively. Diastolic BP tended to have a positive correlation with these outcomes. Further results did show a turning point in the associations of systolic BP with major clinical events, all-cause death and cardiac death, respectively. When the systolic BP level was at 95 mmHg, 105 mmHg and 107 mmHg, respectively, these CHD patients had the lowest risk for the major clinical events, all-cause death and cardiac death. CONCLUSION: Our results demonstrated that accurately lowering systolic BP at a range of 95-107 mmHg may obtain benefits from reducing adverse outcomes including all-cause death and cardiac death for patients with CHD after undergoing PCI. However, further cohort study is needed to support our results.