TY  - BOOK
AU  - Epstein, Stephen E
TI  - Mechanisms underlying the J-curve for diastolic blood pressure: Subclinical myocardial injury and immune activation
SN  - 0167-5273
PY  - 2019///
KW  - *Blood Pressure/ph [Physiology]
KW  - *Coronary Artery Disease/pp [Physiopathology]
KW  - *Immunity, Innate/ph [Physiology]
KW  - *Inflammation Mediators/bl [Blood]
KW  - *Receptors, Urokinase Plasminogen Activator/bl [Blood]
KW  - Aged
KW  - Biomarkers/bl [Blood]
KW  - Coronary Artery Disease/bl [Blood]
KW  - Diastole
KW  - Female
KW  - Follow-Up Studies
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Prognosis
KW  - Prospective Studies
KW  - Risk Factors
KW  - Time Factors
KW  - MedStar Health Research Institute
KW  - Journal Article
N2  - 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; 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; Copyright (c) 2018. Published by Elsevier B.V; 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; 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)
UR  - https://dx.doi.org/10.1016/j.ijcard.2018.09.028
ER  -