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Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: Insights from the EPHESUS trial

European Heart Journal Mar 09, 2020

Böhm M, Ferreira JP, Mahfoud F, et al. - Given that decreased coronary perfusion or simply reverse causation could be responsible for the described link of low diastolic blood pressure (DBP) with increased cardiovascular outcomes, and DBP–risk link might be influenced by coronary reperfusion following myocardial infarction (MI), if DBP is physiologically relevant, so, considering these points, researchers examined the link of achieved DBP with cardiovascular mortality or cardiovascular hospitalization, cardiovascular death, and all-cause mortality among patients (n = 5,929) following acute myocardial infarction (AMI) with impaired left ventricular function, signs and symptoms of heart failure, or diabetes in the EPHESUS trial as per their reperfusion status. Among patients after AMIs with a low DBP, an increased risk was observed, which was sensitive to reperfusion therapy. In patients who were especially carrying a higher risk were identified by the presence of low blood pressure post-MI. These findings lend support to the hypothesis that a link exists between low DBP and risk, potentially involving coronary perfusion pressure, among patients with stenotic coronary lesions, as well as to the recommendations offered by guidelines suggesting lower DBP boundaries for these high-risk patients.
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