In-hospital systolic blood pressure lowering patterns and risk of rehospitalization for angina in patients with hypertension and coronary artery disease.

Abstract

This study aimed to examine the association between in-hospital systolic blood pressure (SBP) lowering patterns and rehospitalization for angina in patients with hypertension and coronary artery disease (HT-CAD). This prospective cohort study was conducted in Chinese PLA General Hospital, Beijing, China. We included 730 patients with HT-CAD, who were hospitalized between August 2020 and September 2022. The in-hospital SBP lowering patterns were identified according to SBP level at admission, SBP level at discharge, and the difference between them: normal-stable SBP, more-intensive SBP reduction, less-intensive SBP reduction, and non-reduced SBP. We used Cox proportional hazards regression to estimate the risk of rehospitalization for angina according to SBP lowering patterns. We identified 121 cases of rehospitalization for angina in a median follow-up of 28.2 months. Patients with more-intensive SBP reduction had the lowest incidence rate of rehospitalization for angina, followed by those with normal-stable SBP, less-intensive SBP reduction, and non-reduced SBP. After adjusting for potential confounders, we found that compared with patients with more-intensive SBP reduction, the hazard ratios and 95% confidence intervals of rehospitalization for angina were 1.35 (0.78-2.35) for patients with normal-stable SBP, 2.17 (1.14-4.14) for patients with less-intensive SBP reduction, and 2.99 (1.57-5.68) for patients with non-reduced SBP. This association was more pronounced in patients with multi-vessel stenosis than in patients with single-vessel stenosis. In conclusion, in-hospital SBP lowering patterns were associated with risk of rehospitalization for angina. These results highlighted the importance of intensive in-hospital SBP control in patients with HT-CAD.