OBJECTIVES: The purpose of this study was to evaluate the effects of normal blood pressure (BP), pre-hypertension, and hypertension on progression of coronary atherosclerosis. BACKGROUND: The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) classifies BP as normal, pre-hypertension, and hypertension. The effects of these categories on progression of coronary atherosclerosis are unknown. METHODS: The 274 patients who completed the intravascular ultrasound (IVUS) substudy of the CAMELOT (Comparison of Amlodipine Versus Enalapril to Limit Occurrences of Thrombosis) trial were included. The entry criteria were > or =1 angiographic coronary stenosis >20% and diastolic BP <100 mm Hg. Patients underwent a baseline coronary IVUS, which was repeated after 2 years of amlodipine, enalapril, or placebo therapy. The BP was evaluated periodically, and the averages of the measurements were used in the analyses. RESULTS:Mean BP throughout the study was 127.0 +/- 12.0/75.5 +/- 6.8 mm Hg. In multivariable analysis, significant determinants of progression included systolic BP (r = 0.16; p = 0.006) and pulse pressure (r = 0.14; p = 0.02). Patients with "hypertensive" average BP had a 12.0 +/- 3.6 mm3 (least-square mean +/- SE) increase in atheroma volume, those with "pre-hypertensive" BP had no major change (0.9 +/- 1.8 mm3), and those with "normal" BP had a decrease of 4.6 +/- 2.6 mm(3) (p < 0.001 by analysis of covariance; p < 0.05 for comparison of all pairs). CONCLUSIONS: The most favorable rate of progression of coronary atherosclerosis is observed in patients whose BP falls within the "normal" JNC-7 category (i.e., systolic BP <120 mm Hg and diastolic BP <80 mm Hg). This study suggests that in patients with coronary artery disease, the optimal BP goal may be substantially lower than the <140/90 mm Hg level.
RCT Entities:
OBJECTIVES: The purpose of this study was to evaluate the effects of normal blood pressure (BP), pre-hypertension, and hypertension on progression of coronary atherosclerosis. BACKGROUND: The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) classifies BP as normal, pre-hypertension, and hypertension. The effects of these categories on progression of coronary atherosclerosis are unknown. METHODS: The 274 patients who completed the intravascular ultrasound (IVUS) substudy of the CAMELOT (Comparison of Amlodipine Versus Enalapril to Limit Occurrences of Thrombosis) trial were included. The entry criteria were > or =1 angiographic coronary stenosis >20% and diastolic BP <100 mm Hg. Patients underwent a baseline coronary IVUS, which was repeated after 2 years of amlodipine, enalapril, or placebo therapy. The BP was evaluated periodically, and the averages of the measurements were used in the analyses. RESULTS: Mean BP throughout the study was 127.0 +/- 12.0/75.5 +/- 6.8 mm Hg. In multivariable analysis, significant determinants of progression included systolic BP (r = 0.16; p = 0.006) and pulse pressure (r = 0.14; p = 0.02). Patients with "hypertensive" average BP had a 12.0 +/- 3.6 mm3 (least-square mean +/- SE) increase in atheroma volume, those with "pre-hypertensive" BP had no major change (0.9 +/- 1.8 mm3), and those with "normal" BP had a decrease of 4.6 +/- 2.6 mm(3) (p < 0.001 by analysis of covariance; p < 0.05 for comparison of all pairs). CONCLUSIONS: The most favorable rate of progression of coronary atherosclerosis is observed in patients whose BP falls within the "normal" JNC-7 category (i.e., systolic BP <120 mm Hg and diastolic BP <80 mm Hg). This study suggests that in patients with coronary artery disease, the optimal BP goal may be substantially lower than the <140/90 mm Hg level.
Authors: Thomas Weber; Irene Lang; Robert Zweiker; Sabine Horn; Rene R Wenzel; Bruno Watschinger; Jörg Slany; Bernd Eber; Franz Xaver Roithinger; Bernhard Metzler Journal: Wien Klin Wochenschr Date: 2016-06-09 Impact factor: 1.704
Authors: William R Zhang; Timothy E Craven; Rakesh Malhotra; Alfred K Cheung; Michel Chonchol; Paul Drawz; Mark J Sarnak; Chirag R Parikh; Michael G Shlipak; Joachim H Ix Journal: Ann Intern Med Date: 2018-10-23 Impact factor: 25.391
Authors: W T Cade; D N Reeds; K E Mondy; E T Overton; J Grassino; S Tucker; C Bopp; E Laciny; S Hubert; S Lassa-Claxton; K E Yarasheski Journal: HIV Med Date: 2010-01-05 Impact factor: 3.180