{
  "abstract": "Background Despite treatment, many hypertensive patients with coronary heart disease (CHD) have blood pressure (BP) that remains above guideline targets. However, less is known about patients in whom on-treatment BP is below target and major European guidelines differ substantially in their recommendations for such patients. Specifically, 2023 European Society of Hypertension (ESH) guidelines provide a Class 3 recommendation to proactively avoid BP below target whereas 2024 European Society of Cardiology (ESC) guidelines do not.Methods Between 2020 and 2023, adults hospitalised in the previous 6–24 months with incident or recurrent CHD were sampled in 14 countries from all six WHO regions and invited for a standardised interview and examination as part of the International Action on Secondary and Primary Prevention by Intervention to Reduce Events (INTERASPIRE) study. We measured seated BP twice using an automated oscillometric device after 5 min of rest. We defined participants as having BP above target (BP ≥130/80 mm Hg), at target (BP 120–129/70-79 mm Hg) or below target (<120/70 mm Hg); according to both 2023 ESH and 2024 ESC guidelines.Results Among 4548 participants (21.1% female), the mean age (±SD) was 60.0 (±10.3) years. At a median (IQR) of 1.05 (0.76–1.45) years after index CHD hospitalisation, 10.3% of patients had BP readings within the target range of 120–129/70-79 mm Hg, with 53.9% above target and 35.7% below target. Patients with below-target BP were more likely to have heart failure (13.6% vs 10.0%, p=0.041) and estimated glomerular filtration rate <60 mL/min/1.73 m² (18.9% vs 10.7%, p<0.001), when compared with those at target. They were also statistically more likely to be severely frail (p=0.030). The median number of BP-lowering medications did not differ significantly between the 3 BP target groups. Cumulative dosing of BP-lowering medications in the below-target group was also not more intensive than that in the at-target group.Conclusions More than one-third of INTERASPIRE patients with CHD presented with BP <120/70 mm Hg, which is below target per current European hypertension guidelines. Further research is needed in this population to resolve discordant guideline recommendations and determine whether de-escalation of BP-lowering therapies is beneficial or even harmful in this setting.",
  "authors": [
    {
      "affiliations": [
        "School of Medicine, University of Galway, Galway, Ireland",
        "National Institute for Prevention and Cardiovascular Health, Galway, Ireland"
      ],
      "name": "John P McCormick"
    },
    {
      "affiliations": [
        "Department of Public Health and Primary Care, Ghent University, Ghent, Belgium"
      ],
      "name": "Dirk De Bacquer"
    },
    {
      "affiliations": [
        "School of Medicine, University of Galway, Galway, Ireland",
        "National Institute for Prevention and Cardiovascular Health, Galway, Ireland"
      ],
      "name": "Catriona Jennings"
    },
    {
      "affiliations": [
        "National Institute for Prevention and Cardiovascular Health, Galway, Ireland",
        "Imperial Cardiovascular Health Service, Imperial College Healthcare NHS Trust, London, UK"
      ],
      "name": "Kornelia Kotseva"
    },
    {
      "affiliations": [
        "Department of Public Health and Primary Care, Ghent University, Ghent, Belgium"
      ],
      "name": "Guy De Backer"
    },
    {
      "affiliations": [
        "Institute for Nutrition and Health Research, Helsinki, Finland"
      ],
      "name": "Iris Erlund"
    },
    {
      "affiliations": [
        "School of Medicine, University of Galway, Galway, Ireland",
        "National Institute for Prevention and Cardiovascular Health, Galway, Ireland"
      ],
      "name": "Sandra Ganly"
    },
    {
      "affiliations": [
        "Institute for Nutrition and Health Research, Helsinki, Finland"
      ],
      "name": "Terhi Vihervaara"
    },
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, Merseyside, UK"
      ],
      "name": "Gregory Y H Lip"
    },
    {
      "affiliations": [
        "Primary Care and Public Health, Imperial College London, London, UK"
      ],
      "name": "Kausik K Ray"
    },
    {
      "affiliations": [
        "Department of Medicine, Cardiology Unit, Karolinska Institute, Stockholm, Sweden"
      ],
      "name": "Lars Rydén"
    },
    {
      "affiliations": [
        "School of Medicine, University of Galway, Galway, Ireland",
        "National Institute for Prevention and Cardiovascular Health, Galway, Ireland"
      ],
      "name": "Agnieszka Adamska"
    },
    {
      "affiliations": [
        "Hospital S Ana, Cardiology Service, University of Lisbon, Lisbon, Portugal"
      ],
      "name": "Ana Abreu"
    },
    {
      "affiliations": [
        "Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE"
      ],
      "name": "Wael Almahmeed"
    },
    {
      "affiliations": [
        "National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia"
      ],
      "name": "Ade Meidian Ambari"
    },
    {
      "affiliations": [
        "Fudan University Zhongshan Hospital, Shanghai, China"
      ],
      "name": "Junbo Ge"
    },
    {
      "affiliations": [
        "Cardiovascular Medicine Department, Assiut University, Asyut, Egypt"
      ],
      "name": "Hosam Hasan-Ali"
    },
    {
      "affiliations": [
        "Peking University First Hospital, Beijing, China"
      ],
      "name": "Yong Huo"
    },
    {
      "affiliations": [
        "Internal Medicine and Geriatric Cardiology, Centre for Postgraduate Medical Education, Warsaw, Poland"
      ],
      "name": "Piotr Jankowski"
    },
    {
      "affiliations": [
        "Philippine Heart Association and St Luke’s Medical Center, St Luke’s Medical Center, Global City, Indonesia"
      ],
      "name": "Rodney M Jimenez"
    },
    {
      "affiliations": [
        "Huashan Hospital Fudan University, Shanghai, China"
      ],
      "name": "Yong Li"
    },
    {
      "affiliations": [
        "Department of Medicine, Cardiology Unit, Kuala Lumpur, Malaysia"
      ],
      "name": "Ahmad Syadi Mahmood Zuhdi"
    },
    {
      "affiliations": [
        "Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Tanzania, United Republic of"
      ],
      "name": "Abel Makubi"
    },
    {
      "affiliations": [
        "Medicine, University of Lagos College of Medicine, Lagos, Nigeria"
      ],
      "name": "Amam C Mbakwem"
    },
    {
      "affiliations": [
        "Kenya Cardiac Society, Nairobi, Kenya"
      ],
      "name": "Lilian Mbau"
    },
    {
      "affiliations": [
        "Italian Hospital of Buenos Aires, Buenos Aires, Argentina"
      ],
      "name": "Jose L Navarro Estrada"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Ibadan, Ibadan, Nigeria"
      ],
      "name": "Okechukwu Samuel Ogah"
    },
    {
      "affiliations": [
        "Department of Clinical Medicine, University of Nairobi, Nairobi, Kenya"
      ],
      "name": "Elijah Nyainda Ogola"
    },
    {
      "affiliations": [
        "Faculty of Health Sciences, Simon Bolivar University Life Sciences Research Center, Barranquilla, Colombia"
      ],
      "name": "Adalberto Quintero-Baiz"
    },
    {
      "affiliations": [
        "Department of Medicine, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria"
      ],
      "name": "Mahmoud U Sani"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Hospital Sanatorio Güemes, Buenos Aires, Argentina"
      ],
      "name": "Maria Ines Sosa Liprandi"
    },
    {
      "affiliations": [
        "National Heart Centre Singapore, Duke-NUS Medical School, Singapore"
      ],
      "name": "Jack Wei Chieh Tan"
    },
    {
      "affiliations": [
        "Faculty of Health Sciences, Simon Bolivar University Life Sciences Research Center, Barranquilla, Colombia"
      ],
      "name": "Miguel Alberto Urina Triana"
    },
    {
      "affiliations": [
        "Cardiac, National University Heart Centre, Singapore"
      ],
      "name": "Tee Joo Yeo"
    },
    {
      "affiliations": [
        "School of Medicine, University of Galway, Galway, Ireland",
        "National Institute for Prevention and Cardiovascular Health, Galway, Ireland"
      ],
      "name": "David Wood"
    },
    {
      "affiliations": [
        "School of Medicine, University of Galway, Galway, Ireland",
        "National Institute for Prevention and Cardiovascular Health, Galway, Ireland",
        "Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA"
      ],
      "name": "John William McEvoy"
    }
  ],
  "title": "Prevalence and characteristics of patients with coronary heart disease and blood pressure below target: the INTERASPIRE study",
  "uid": "e46beefc-0f2f-54c9-9c29-b02797161601"
}