Diastolic Blood Pressure in Coronary Artery Disease
Authors: Thomas Weber, Johann Auer, Bernd Eber, Michael F. O'Rourke
Journal: Annals of Internal Medicine (2007)

Letters16 January 2007Diastolic Blood Pressure in Coronary Artery DiseaseThomas Weber, MD, Johann Auer, MD, Bernd Eber, MD, and Michael F. O'Rourke, MDThomas Weber, MDFrom Klinikum Wels, Wels, Austria, and St. Vincent's Clinic, Sydney, Australia., Johann Auer, MDFrom Klinikum Wels, Wels, Austria, and St. Vincent's Clinic, Sydney, Australia., Bernd Eber, MDFrom Klinikum Wels, Wels, Austria, and St. Vincent's Clinic, Sydney, Australia., and Michael F. O'Rourke, MDFrom Klinikum Wels, Wels, Austria, and St. Vincent's Clinic, Sydney, Australia.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-2-200701160-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: Messerli and colleagues (1) provide new insights into the J-curve discussion in hypertensive patients with coronary artery disease (CAD). Briefly, they observed an increase in all-cause mortality and myocardial infarctions with lower diastolic blood pressure in patients from the International Verapamil-Trandolapril Study (INVEST) (2), hypertensive patients with CAD, who were treated with a verapamil sustained-release–based or atenolol-based strategy. The authors mention impaired coronary perfusion, increased pulse pressure and arterial stiffness, and underlying chronic illness as possible pathophysiologic mechanisms.Clearly, we cannot speculate on the latter mechanism, but we would like to support the 2 other explanations. First, ...References1. Messerli FH, Mancia G, Conti CR, Hewkin AC, Kupfer S, Champion A, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006;144:884-93. [PMID: 16785477] LinkGoogle Scholar2. Pepine CJ, Handberg EM, Cooper-DeHoff RM, Marks RG, Kowey P, Messerli FH, et al. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized, controlled trial. JAMA. 2003;290:2805-16. [PMID: 14657064] CrossrefMedlineGoogle Scholar3. Franklin SS, Jacobs MJ, Wong ND, L'Italien GJ, Lapuerta P. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension. 2001;37:869-74. [PMID: 11244010] CrossrefMedlineGoogle Scholar4. Nichols WW, O'Rourke MF. McDonald's Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles. 5th ed. London: Hodder-Arnold; 2005. Google Scholar5. Franklin SS. Hypertension in older people: part 1. J Clin Hypertens (Greenwich). 2006;8:444-9. [PMID: 16760685] CrossrefMedlineGoogle Scholar6. Chirinos JA, Zambrano JP, Chakko S, Veerani A, Schob A, Willens HJ, et al. Aortic pressure augmentation predicts adverse cardiovascular events in patients with established coronary artery disease. Hypertension. 2005;45:980-5. [PMID: 15837821] CrossrefMedlineGoogle Scholar7. Weber T, Auer J, O'Rourke MF, Kvas E, Lassnig E, Lamm G, et al. Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. Eur Heart J. 2005;26:2657-63. [PMID: 16183688] CrossrefMedlineGoogle Scholar8. Weber T, Auer J, O'Rourke MF, Kvas E, Lassnig E, Berent R, et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation. 2004;109:184-9. [PMID: 14662706] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Klinikum Wels, Wels, Austria, and St. Vincent's Clinic, Sydney, Australia.Disclosures: Dr. O'Rourke is a funding director of AtCor Medical, a manufacturer of systems for pulse-wave form analysis. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDogma Disputed: Can Aggressively Lowering Blood Pressure in Hypertensive Patients with Coronary Artery Disease Be Dangerous? Franz H. Messerli , Giuseppe Mancia , C. Richard Conti , Ann C. Hewkin , Stuart Kupfer , Annette Champion , Rainer Kolloch , Athanase Benetos , and Carl J. Pepine Metrics Cited byPrehypertension: Progression to hypertension and management considerationsThe Atlantic Coast of German Trade: German Rural Industry and Trade in the Atlantic, 1680–1840 16 January 2007Volume 146, Issue 2Page: 149KeywordsBlood pressureConflicts of interestHypertensionMyocardial infarctionPhenotypesRisk managementStable coronary artery diseaseStiffnessSystolic pressure ePublished: 16 January 2007 Issue Published: 16 January 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...