The impact of blood pressure guidelines on the cardiovascular event risk in Japanese patients with coronary artery disease in a real-world database using a multimodal data acquisition system

Abstract Background The European Society of Hypertension and the Japanese Society of Hypertension have established a blood pressure (BP) guideline for coronary artery disease (CAD): 130/80 mmHg. The impact of adhering to this BP guideline on the prognosis of Japanese patients with CAD after they have undergone percutaneous coronary intervention (PCI) is unclear. Purpose We investigated the impact of the current guideline-recommended BP value 130/80 mmHg on the prognosis of Japanese patients with CAD by using 'big data,' i.e., the Clinical Deep Data Accumulation System (CLIDAS) database. Methods We evaluated the data of 8,793 CAD patients who underwent cardiac catheterization at six university hospitals and Japan's National Cerebral and Cardiovascular Center (mean ± std. dev. 70 ± 11 years, 78% male, 43% with acute coronary syndrome [ACS]). We categorized the patients based on their BP management: those adhering to the guideline-recommended BP (<130/80 mmHg) and those under stricter BP control criteria (<120/70 mmHg and <110/60 mmHg). We compared the incidence of major adverse cardiovascular events (MACCEs) between these groups, with MACCEs being a composite endpoint (cardiovascular death, stroke, and myocardial infarction). We analyzed the relationship between BP classification and MACCE separately in two groups: the patients with ACS and those with chronic coronary syndrome (CCS). Results During an average follow-up period of 33 months, 710 MACCEs occurred, comprising 234 cardiovascular deaths, 305 strokes, and 270 myocardial infarctions, with some cases overlapping. No significant difference in the MACCE rate was observed between the group with BP below 130/80 mmHg and the group with BP above 130/80 mmHg (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.75–1.04, p=0.133). In the ACS group, the patients maintaining BP below 130/80 mmHg had a significantly lower MACCE incidence (HR 0.75, 95%CI: 0.59–0.95, p=0.017) and a significantly lower incidence of stroke (HR 0.47, 95%CI: 0.33–0.68, p<0.001), whereas no significant difference in the MACCE incidence was observed in the CCS group (HR 0.91, 95%CI: 0.73–1.13, p=0.393). Blood pressure values below 120/70 mmHg (HR 1.13, 95%CI: 0.97–1.31, p=0.109) and 110/60 mmHg (HR 1.23, 95%CI: 1.06–1.43, p=0.008), corresponded to an increased rate of MACCEs, becoming more pronounced at BP values <110/60 mmHg. Conclusion Achieving the BP guideline target of <130/80 mmHg is associated with improved outcomes in CAD patients, particularly regarding reducing the risk of stroke among patients with ACS. However, BP control at values that are too low may potentially worsen the prognosis for CAD patients.Kaplan–Meier curve