Poghni A Peri-Okonny1, Krishna K Patel2, Philip G Jones2, Tracie Breeding3, Kensey L Gosch3, John A Spertus2, Suzanne V Arnold2. 1. Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: periokonnyp@umkc.edu. 2. Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri. 3. Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Abstract
BACKGROUND: In patients with coronary artery disease (CAD), low diastolic blood pressure (DBP) is associated with increased risk of myocardial infarction, but its association with angina is unknown. OBJECTIVES: The goal of this study was to examine the association of low DBP and angina in patients with CAD. METHODS: The study assessed the frequency of angina (measured by using the Seattle Angina Questionnaire-Angina Frequency score) according to DBP in patients with known CAD from 25 U.S. cardiology clinics. Hierarchical logistic regression was used to test the association between DBP and angina, with a spline term for DBP to assess nonlinearity. RESULTS: Among 1,259 outpatients with CAD, 411 (33%) reported angina in the prior month, with higher rates in the lowest DBP quartile (40 to 64 mm Hg: 37%). In the unadjusted model, DBP was associated with angina with a J-shaped relationship (p = 0.017, p for nonlinearity = 0.027), with a progressive increase in odds of angina as DBP decreased below ∼70 to 80 mm Hg. This association remained significant after sequential adjustment for demographic characteristics (p = 0.002), comorbidities (p = 0.002), heart rate (p = 0.002), systolic blood pressure (p = 0.046), and antihypertensive antianginal medications (p = 0.045). CONCLUSIONS: In patients with chronic CAD, there seemed to be an association between lower DBP and increased odds of angina. If validated, these findings suggest that clinicians should consider less aggressive blood pressure control in patients with CAD and angina.
BACKGROUND: In patients with coronary artery disease (CAD), low diastolic blood pressure (DBP) is associated with increased risk of myocardial infarction, but its association with angina is unknown. OBJECTIVES: The goal of this study was to examine the association of low DBP and angina in patients with CAD. METHODS: The study assessed the frequency of angina (measured by using the Seattle Angina Questionnaire-Angina Frequency score) according to DBP in patients with known CAD from 25 U.S. cardiology clinics. Hierarchical logistic regression was used to test the association between DBP and angina, with a spline term for DBP to assess nonlinearity. RESULTS: Among 1,259 outpatients with CAD, 411 (33%) reported angina in the prior month, with higher rates in the lowest DBP quartile (40 to 64 mm Hg: 37%). In the unadjusted model, DBP was associated with angina with a J-shaped relationship (p = 0.017, p for nonlinearity = 0.027), with a progressive increase in odds of angina as DBP decreased below ∼70 to 80 mm Hg. This association remained significant after sequential adjustment for demographic characteristics (p = 0.002), comorbidities (p = 0.002), heart rate (p = 0.002), systolic blood pressure (p = 0.046), and antihypertensive antianginal medications (p = 0.045). CONCLUSIONS: In patients with chronic CAD, there seemed to be an association between lower DBP and increased odds of angina. If validated, these findings suggest that clinicians should consider less aggressive blood pressure control in patients with CAD and angina.
Authors: Clive Rosendorff; Daniel T Lackland; Matthew Allison; Wilbert S Aronow; Henry R Black; Roger S Blumenthal; Christopher P Cannon; James A de Lemos; William J Elliott; Laura Findeiss; Bernard J Gersh; Joel M Gore; Daniel Levy; Janet B Long; Christopher M O'Connor; Patrick T O'Gara; Gbenga Ogedegbe; Suzanne Oparil; William B White Journal: Hypertension Date: 2015-03-31 Impact factor: 10.190
Authors: Paul K Whelton; Robert M Carey; Wilbert S Aronow; Donald E Casey; Karen J Collins; Cheryl Dennison Himmelfarb; Sondra M DePalma; Samuel Gidding; Kenneth A Jamerson; Daniel W Jones; Eric J MacLaughlin; Paul Muntner; Bruce Ovbiagele; Sidney C Smith; Crystal C Spencer; Randall S Stafford; Sandra J Taler; Randal J Thomas; Kim A Williams; Jeff D Williamson; Jackson T Wright Journal: Hypertension Date: 2017-11-13 Impact factor: 10.190
Authors: William C Cushman; Gregory W Evans; Robert P Byington; David C Goff; Richard H Grimm; Jeffrey A Cutler; Denise G Simons-Morton; Jan N Basile; Marshall A Corson; Jeffrey L Probstfield; Lois Katz; Kevin A Peterson; William T Friedewald; John B Buse; J Thomas Bigger; Hertzel C Gerstein; Faramarz Ismail-Beigi Journal: N Engl J Med Date: 2010-03-14 Impact factor: 91.245
Authors: J A Spertus; J A Winder; T A Dewhurst; R A Deyo; J Prodzinski; M McDonell; S D Fihn Journal: J Am Coll Cardiol Date: 1995-02 Impact factor: 24.094
Authors: Srinivasan Beddhu; Glenn M Chertow; Alfred K Cheung; William C Cushman; Tom Greene; Guo Wei; Robert Boucher; Paul K Whelton Journal: Circulation Date: 2018-06-12 Impact factor: 29.690
Authors: David J A Jenkins; Sandhya Sahye-Pudaruth; Khosrow Khodabandehlou; Fred Liang; Maaria Kasmani; Jessica Wanyan; Maggie Wang; Keishini Selvaganesh; Melanie Paquette; Darshna Patel; Andrea J Glenn; Korbua Srichaikul; Cyril W C Kendall; John L Sievenpiper Journal: Am J Clin Nutr Date: 2022-09-02 Impact factor: 8.472
Authors: Brian R Lindman; Kashish Goel; Javier Bermejo; Joshua Beckman; Jared O'Leary; Colin M Barker; Clayton Kaiser; João L Cavalcante; Sammy Elmariah; Jian Huang; Graeme L Hickey; David H Adams; Jeffrey J Popma; Michael J Reardon Journal: J Am Heart Assoc Date: 2019-10-31 Impact factor: 5.501
Authors: Magnus O Wijkman; Brian Claggett; Rafael Diaz; Hertzel C Gerstein; Lars Køber; Eldrin Lewis; Aldo P Maggioni; Emil Wolsk; David Aguilar; Rhonda Bentley-Lewis; John J McMurray; Jeffrey Probstfield; Matthew Riddle; Jean-Claude Tardif; Scott D Solomon; Marc A Pfeffer Journal: Cardiovasc Diabetol Date: 2020-10-12 Impact factor: 9.951