MedStar Authors catalog › Details for: Mechanisms underlying the J-curve for diastolic blood pressure: Subclinical myocardial injury and immune activation.
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Mechanisms underlying the J-curve for diastolic blood pressure: Subclinical myocardial injury and immune activation.

by Epstein, Stephen E.
Citation: International Journal of Cardiology. 2018 Sep 08.Journal: International journal of cardiology.Published: ; 2018ISSN: 0167-5273.Full author list: Topel ML; Sandesara PB; Stahl EP; Hayek SS; Tahhan AS; O'Neal WT; Ko YA; Alkhoder A; Gafeer MM; Kim JH; Wilson PWF; Shaw LJ; Epstein SE; Vaccarino V; Sperling LS; Quyyumi AA.UI/PMID: 30217423.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Health Research InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.ijcard.2018.09.028 (Click here) Abbreviated citation: Int J Cardiol. 2018 Sep 08.Abstract: BACKGROUND: Low diastolic blood pressure (DBP) is associated with increased risk of cardiovascular events. In patients with coronary artery disease (CAD), limitations in coronary blood flow and immune activity are implicated mechanisms, but evidence is lacking. We investigated the association between DBP, biomarkers of myocardial injury, inflammation, immune activation and incident events in patients with CAD.Abstract: METHODS: We studied 2448 adults (mean age 65+/-12years, 68% male, median follow-up 4.5years) with CAD. DBP was categorized into 10mmHg increments. Biomarkers of myocardial injury (high sensitivity cardiac troponin-I [hs-cTnI]) and immune activity/inflammation (soluble urokinase plasminogen activator receptor [suPAR]) were dichotomized at their median values. DBP 70-79mmHg was used as the referent group, and individuals were followed prospectively for adverse outcomes.Abstract: RESULTS: After adjusting for demographic and clinical covariates, individuals with DBP<60mmHg had increased odds of elevated levels of hs-cTnI (OR=1.68; 95% CI=1.07, 2.65) and suPAR (OR=1.71; 95% CI=1.10, 2.65) compared to the referent group. Additionally, DBP<60mmHg was associated with increased adjusted risk of cardiovascular death or MI (HR=2.04; 95% CI=1.32, 3.16) and all-cause mortality (HR=2.41; 95% CI=1.69, 3.45).Abstract: CONCLUSION: In patients with CAD, DBP<60mmHg is associated with subclinical myocardial injury, immune/inflammatory dysregulation and incident events. Aggressive BP control may be harmful in these patients, and further investigation is warranted to determine appropriate BP targets in patients with CAD.Abstract: Copyright (c) 2018. Published by Elsevier B.V.

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