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Article

Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study

1
Department of Internal Medicine, Hospital San Pedro Alcántara, 10003 Cáceres, Spain
2
Department of Internal Medicine, Hospital Virgen Del Puerto, Plasencia, 10003 Cáceres, Spain
3
Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain
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Department of Nephrology, Hospital Infanta Cristina, 06080 Badajoz, Spain
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Centro de Salud Manuel Encinas, 10001 Cáceres, Spain
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Department of Internal Medicine, Hospital Comarcal Valle de los Pedroches, 14400 Pozoblanco, Spain
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Department of Nursing, Faculty of Medicine, University of Extremadura, 06080 Badajoz, Spain
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Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, 08916 Barcelona, Spain
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
A full list of the FRENA Investigators is given in the Appendix A.
Academic Editor: Calogera Pisano
Int. J. Environ. Res. Public Health 2021, 18(17), 9348; https://doi.org/10.3390/ijerph18179348
Received: 15 July 2021 / Revised: 24 August 2021 / Accepted: 30 August 2021 / Published: 4 September 2021
(This article belongs to the Special Issue New Advances in Cardiovascular Diseases)
Objectives: The most appropriate targets for systolic blood pressure (SBP) levels to reduce cardiovascular morbidity and mortality in patients with symptomatic artery disease remain controversial. We compared the rate of subsequent ischemic events or death according to mean SBP levels during follow-up. Design: Prospective cohort study. FRENA is an ongoing registry of stable outpatients with symptomatic coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD). Setting: 24 Spanish hospitals. Participants: 4789 stable outpatients with vascular disease. Results: As of June 2017, 4789 patients had been enrolled in different Spanish centres. Of these, 1722 (36%) had CAD, 1383 (29%) CVD and 1684 (35%) PAD. Over a mean follow-up of 18 months, 136 patients suffered subsequent myocardial infarction, 125 had ischemic stroke, 74 underwent limb amputation, and 260 died. On multivariable analysis, CVD patients with mean SBP levels 130–140 mm Hg had a lower risk of mortality than those with levels <130 mm Hg (hazard ratio (HR): 0.39; 95% CI: 0.20–0.77), as did those with levels >140 mm Hg (HR: 0.46; 95% CI: 0.26–0.84). PAD patients with mean SBP levels >140 mm Hg had a lower risk for subsequent ischemic events (HR: 0.57; 95% CI: 0.39–0.83) and those with levels 130–140 mm Hg (HR: 0.47; 95% CI: 0.29–0.78) or >140 mm Hg (HR: 0.32; 95% CI: 0.21–0.50) had a lower risk of mortality. We found no differences in patients with CAD. Conclusions: In this real-world cohort of symptomatic arterial disease patients, most of whom are not eligible for clinical trials, the risk of subsequent events and death varies according to the levels of SBP and the location of previous events. Especially among patients with large artery atherosclerosis, PAD or CVD, SBP <130 mm Hg may result in increased mortality. Due to potential factors in this issue, Prospective, well designed studies are warranted to confirm these observational data. View Full-Text
Keywords: systolic blood pressure; outcomes; symptomatic artery disease; ischemic event; death systolic blood pressure; outcomes; symptomatic artery disease; ischemic event; death
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MDPI and ACS Style

Sánchez Muñoz-Torrero, J.F.; Escudero-Sánchez, G.; Calderón-García, J.F.; Rico-Martín, S.; Robles, N.R.; Bacaicoa, M.A.; Alcalá-Pedrajas, J.N.; Gil-Fernández, G.; Monreal, M.; on behalf of the FRENA Investigators. Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study. Int. J. Environ. Res. Public Health 2021, 18, 9348. https://doi.org/10.3390/ijerph18179348

AMA Style

Sánchez Muñoz-Torrero JF, Escudero-Sánchez G, Calderón-García JF, Rico-Martín S, Robles NR, Bacaicoa MA, Alcalá-Pedrajas JN, Gil-Fernández G, Monreal M, on behalf of the FRENA Investigators. Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study. International Journal of Environmental Research and Public Health. 2021; 18(17):9348. https://doi.org/10.3390/ijerph18179348

Chicago/Turabian Style

Sánchez Muñoz-Torrero, Juan F., Guillermo Escudero-Sánchez, Julián F. Calderón-García, Sergio Rico-Martín, Nicolás R. Robles, M. A. Bacaicoa, José N. Alcalá-Pedrajas, Guadalupe Gil-Fernández, Manuel Monreal, and on behalf of the FRENA Investigators. 2021. "Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study" International Journal of Environmental Research and Public Health 18, no. 17: 9348. https://doi.org/10.3390/ijerph18179348

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