Association of systolic blood pressure target and variability with long-term clinical outcomes in patients undergoing percutaneous coronary intervention.

IF 2.6 Q2 PERIPHERAL VASCULAR DISEASE

Clinical Hypertension Pub Date : 2025-04-01 eCollection Date: 2025-01-01 DOI:10.5646/ch.2025.31.e13

Byung Sik Kim, Young-Hyo Lim, Jinho Shin, Jeong-Hun Shin

{"title":"Association of systolic blood pressure target and variability with long-term clinical outcomes in patients undergoing percutaneous coronary intervention.","authors":"Byung Sik Kim, Young-Hyo Lim, Jinho Shin, Jeong-Hun Shin","doi":"10.5646/ch.2025.31.e13","DOIUrl":null,"url":null,"abstract":"Background: The combined impact of achieving target systolic blood pressure (SBP) and blood pressure variability (BPV) on long-term clinical outcomes in patients with coronary artery disease following percutaneous coronary intervention (PCI) remains unclear. This study aimed to investigate the combined effect of SBP target achievement and BPV on the risk of cardiovascular events in patients undergoing PCI.Methods: Consecutive patients who underwent PCI between 2012 and 2016 were included. Patients were classified into four groups based on average follow-up SBP (< 130 or ≥ 130 mmHg) and BPV (categorized as low or high, using the median of the standard deviation of SBP during follow-up). The primary outcome was net adverse clinical events (NACE; defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or major bleeding) for up to 5 years.Results: Among 2,845 patients, 787 (27.7%) experienced NACE during a median follow-up of 5.43 years. Patients with high BPV had a significantly increased risk of long-term clinical outcomes, regardless of whether the target SBP was achieved. Additionally, patients with SBP ≥ 130 mmHg and high BPV had a significantly higher risk of 5-year major adverse cardiac and cerebrovascular events (adjusted hazard ratio [HR], 1.342; 95% confidence interval [CI], 1.067-1.688; P = 0.012) and NACE (adjusted HR, 1.262; 95% CI, 1.036-1.537; P = 0.021) than those with SBP < 130 mmHg and low BPV.Conclusions: The combined impact of SBP target achievement and BPV was significantly associated with the risk of long-term adverse outcomes in patients who underwent PCI. These findings underscore the importance of achieving target SBP while recognizing that patients with high BPV represent a high-risk group requiring focused monitoring and management to mitigate cardiovascular events.Trial registration: ClinicalTrials.gov Identifier: NCT05935397.","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"31 ","pages":"e13"},"PeriodicalIF":2.6000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975637/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Hypertension","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5646/ch.2025.31.e13","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The combined impact of achieving target systolic blood pressure (SBP) and blood pressure variability (BPV) on long-term clinical outcomes in patients with coronary artery disease following percutaneous coronary intervention (PCI) remains unclear. This study aimed to investigate the combined effect of SBP target achievement and BPV on the risk of cardiovascular events in patients undergoing PCI.

Methods: Consecutive patients who underwent PCI between 2012 and 2016 were included. Patients were classified into four groups based on average follow-up SBP (< 130 or ≥ 130 mmHg) and BPV (categorized as low or high, using the median of the standard deviation of SBP during follow-up). The primary outcome was net adverse clinical events (NACE; defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or major bleeding) for up to 5 years.

Results: Among 2,845 patients, 787 (27.7%) experienced NACE during a median follow-up of 5.43 years. Patients with high BPV had a significantly increased risk of long-term clinical outcomes, regardless of whether the target SBP was achieved. Additionally, patients with SBP ≥ 130 mmHg and high BPV had a significantly higher risk of 5-year major adverse cardiac and cerebrovascular events (adjusted hazard ratio [HR], 1.342; 95% confidence interval [CI], 1.067-1.688; P = 0.012) and NACE (adjusted HR, 1.262; 95% CI, 1.036-1.537; P = 0.021) than those with SBP < 130 mmHg and low BPV.

Conclusions: The combined impact of SBP target achievement and BPV was significantly associated with the risk of long-term adverse outcomes in patients who underwent PCI. These findings underscore the importance of achieving target SBP while recognizing that patients with high BPV represent a high-risk group requiring focused monitoring and management to mitigate cardiovascular events.

Trial registration: ClinicalTrials.gov Identifier: NCT05935397.

查看原文本刊更多论文

经皮冠状动脉介入治疗患者收缩压目标和变异性与长期临床结果的关系

背景：达到目标收缩压（SBP）和血压变异性（BPV）对冠状动脉疾病患者经皮冠状动脉介入治疗（PCI）后长期临床结果的综合影响尚不清楚。本研究旨在探讨收缩压目标达到和BPV对PCI患者心血管事件风险的联合影响。方法：纳入2012 - 2016年间连续行PCI的患者。根据平均随访收缩压（< 130或≥130 mmHg）和BPV（使用随访期间收缩压标准偏差的中位数分为低或高）将患者分为四组。主要终点是净不良临床事件(NACE；定义为长达5年的全因死亡，非致死性心肌梗死，非致死性中风，任何血运重建术或大出血。结果：在2,845例患者中，787例（27.7%）在中位随访5.43年期间经历了NACE。无论是否达到目标收缩压，高BPV患者的长期临床结果风险显著增加。此外，收缩压≥130 mmHg和BPV高的患者发生5年主要心脑血管不良事件的风险明显更高(校正风险比[HR]， 1.342；95%置信区间[CI]， 1.067-1.688；P = 0.012)和NACE(调整后HR为1.262；95% ci, 1.036-1.537；P = 0.021)高于收缩压< 130 mmHg和BPV低的患者。结论：收缩压目标实现和BPV的综合影响与PCI患者长期不良结局的风险显著相关。这些发现强调了达到收缩压目标的重要性，同时认识到高BPV患者是一个需要重点监测和管理以减轻心血管事件的高风险群体。试验注册：ClinicalTrials.gov标识符：NCT05935397。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊