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Effects of lowering diastolic blood pressure to <80 mmHg on cardiovascular mortality and events in patients with coronary artery disease: a systematic review and meta-analysis

Abstract

The target of diastolic blood pressure (DBP) remains controversial in patients with coronary artery disease (CAD). We systematically searched PubMed/Medline and the Cochrane Central database for randomized controlled trials (RCTs) assessing the efficacy and safety of reducing DBP in CAD patients from January 1965 to July 2017. Seven placebo-controlled RCTs enrolling 34,814 CAD patients who achieved DBP <80 mmHg were included in the drug-intervention group. The average achieved blood pressures (BPs) were 126.3/75.1 and 131.5/77.8 mmHg in the drug-intervention and placebo-control groups, respectively. Drug intervention was associated with an 11% reduction in coronary revascularization and a 31% reduction in heart failure. In the drug-intervention group, all-cause death, myocardial infarction, angina pectoris, and stroke were reduced with marginal significance, whereas hypotension was increased by 123%. A meta-analysis of four RCTs, in which the achieved DBP was <75 mmHg, showed that the drug intervention was associated with a 22% reduction in heart failure. These results suggest that reducing DBP to 80 mmHg or less would significantly reduce coronary revascularization and heart failure but at the expense of causing hypotension in CAD patients. Further trials are warranted to prove this issue.

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Correspondence to Ryuji Okamoto.

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Conflict of interest

The Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, received research grants from Bristol-Myers Squibb, MSD K.K., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., Daiichi Sankyo Pharmaceutical Co., Ltd., Genzyme Japan, Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Mitsubishi Tanabe Corporation, Otsuka Pharmaceutical Co., Ltd., Bayer Yakuhin, Ltd., AstraZeneca K.K., and Boehringer Ingelheim Co., Ltd. Rei Shibata received honoraria from Medtoronic, Boehringer Ingelheim, Eli Lilly and Mitsubishi Tanabe Pharma. Toshio Ohtsubo received lecture fees from Sanwa Kagaku Kenkyusho Co., Ltd. Hisashi Kai received lecture fees from Daiichi Sankyo Co Pharmaceutical Co., Ltd., Mitsubishi Tanabe Corporation, Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., and Takeda Pharmaceutical Co., Ltd. Masaaki Ito received lecture fees from Daiichi Sankyo Co Pharmaceutical Co., Ltd., Mitsubishi Tanabe Corporation, Bayer Yakuhin, Ltd. and Takeda Pharmaceutical Co., Ltd.

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Okamoto, R., Kumagai, E., Kai, H. et al. Effects of lowering diastolic blood pressure to <80 mmHg on cardiovascular mortality and events in patients with coronary artery disease: a systematic review and meta-analysis. Hypertens Res 42, 650–659 (2019). https://doi.org/10.1038/s41440-018-0189-z

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  • DOI: https://doi.org/10.1038/s41440-018-0189-z

Keywords

  • Coronary artery disease
  • diastolic blood pressure
  • hypertension
  • J curve
  • meta-analysis

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