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Myocardial perfusion and the J curve association between diastolic blood pressure and mortality

Citation

Schultz, MG and Abhayaratna, WP and Marwick, TH and Sharman, JE, Myocardial perfusion and the J curve association between diastolic blood pressure and mortality, American Journal of Hypertension, 26, (4) pp. 557-566. ISSN 0895-7061 (2013) [Refereed Article]

Copyright Statement

Copyright 2013 American Journal of Hypertension, Ltd

DOI: doi:10.1093/ajh/hps077

Abstract

BACKGROUND: The J-curve relationship between brachial diastolic blood pressure (DBP) and mortality is believed to be mediated through reduced myocardial perfusion. This study aimed to determine the relationship between DBP and subendocardial perfusion in patients with and without coronary artery disease (CAD) and to examine central hemodynamic variables that may explain the risk associated with low DBP (aortic stiffness, central pulse pressure, and augmentation index). METHODS: Brachial DBP and radial tonometry were measured in 134 patients with CAD (aged 767years; 69% male), 134 individuals without a prior cardiovascular event (control subjects) (aged 772years; 69% male) and 47 patients (aged 6310years) during dobutamine stress echocardiography. Central hemodynamics and subendocardial viability ratio (SEVR), a marker of subendocardial perfusion, were recorded by tonometry. RESULTS: There was no difference in DBP or SEVR between control subjects and CAD patients (P > 0.05), nor was there a difference in SEVR across quartiles of DBP in CAD patients (P = 0.07) or control subjects (P = 0.14). After adjustment for age and height, associations between DBP and SEVR in control subjects (r = 0.185; P = 0.03) and CAD patients (r = 0.204; P = 0.02) were attenuated (P = 0.07 and P = 0.11, respectively). There were no significant relationships between DBP and central hemodynamics (P > 0.05 for all). At peak dobutamine stress, SEVR was significantly reduced in patients with inducible ischemia vs. those with nonischemic response (8417 vs. 10122%; P = 0.01). However, DBP was not significantly different (6514 vs. 6715mm Hg; P = 0.32). CONCLUSIONS: Brachial DBP is a poor marker of subendocardial perfusion. The J-curve relationship between DBP and mortality is unlikely attributable to reduced myocardial perfusion or adverse central hemodynamics.

Item Details

Item Type:Refereed Article
Keywords:blood pressure; hypertension; ischemia; left ventricle; pressure waveform analysis; pulse pressure; subendocardial viability ratio
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Schultz, MG (Dr Martin Schultz)
Author:Sharman, JE (Professor James Sharman)
ID Code:84228
Year Published:2013
Web of Science® Times Cited:3
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-04-30
Last Modified:2014-04-17
Downloads:0

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