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Yang YL, Chen SC, Wu CH, Huang SS, Chan WL, Lin SJ, Chou CY, Chen JW, Ju-Pin P, Charng MJ, Chen YH, Wu TC, Lu TM, Hsu PF, Huang PH, Cheng HM, Huang CC, Sung SH, Lin YJ, Leu HB. Optimal blood pressure for patients with end-stage renal disease following coronary interventions. J Clin Hypertens (Greenwich) 2021; 23:1622-1630. [PMID: 34263995 PMCID: PMC8678782 DOI: 10.1111/jch.14325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/11/2021] [Accepted: 07/02/2021] [Indexed: 12/01/2022]
Abstract
Hypertension is a frequent manifestation of chronic kidney disease but the ideal blood pressure (BP) target in patients with coronary artery disease (CAD) with end-stage renal disease (ESRD) (eGFR < 15 ml/min/1.73m2 ) still unclear. The authors aimed to investigate the ideal achieved BP in ESRD patients with CAD after coronary intervention. Five hundred and seventy-five ESRD patients who had undergone percutaneous coronary interventions (PCIs) were enrolled and their clinical outcomes were analyzed according to the category of systolic BP (SBP) and diastolic BP (DBP) achieved. The clinical outcomes included major cardiovascular events (MACE) and MACE plus hospitalization for congestive heart failure (total cardiovascular (CV) event).The mean systolic BP was 135.0 ± 24.7 mm Hg and the mean diastolic BP was 70.7 ± 13.1 mm Hg. Systolic BP 140-149 mm Hg and diastolic BP 80-89 mm Hg had the lowest MACE (11.0%; 13.2%) and total CV event (23.3%; 21.1%). Patients with systolic BP < 120 mm Hg had a higher risk of MACE (HR: 2.01; 95% CI: 1.17-3.46, p = .008) than those with systolic BP 140-149 mm Hg. Patients with systolic BP ≥ 160 mm Hg (HR: 1.84; 95% CI, 3.27-1.04, p = .04) and diastolic blood BP ≥ 90 mm Hg (HR: 2.19; 95% CI: 1.15-4.16, p = .02) had a higher risk of total CV event rate when compared to those with systolic BP 140-149 mm Hg and diastolic BP 80-89 mm Hg. A J-shaped association between systolic (140-149 mm Hg) and diastolic (80-89 mm Hg) BP and decreased cardiovascular events for CAD was found in patients with ESRD after undergoing PCI in non-Western population.
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Affiliation(s)
- Ya-Ling Yang
- Division of Cardiology, Department of Medicine, Cardinal Tien Hospital, Taiwan, ROC.,Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC
| | - Su-Chan Chen
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Hsueh Wu
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Sung Huang
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan Leong Chan
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shing-Jong Lin
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Yu Chou
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jaw-Wen Chen
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pan Ju-Pin
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Min-Ji Charng
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Hwa Chen
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tao-Cheng Wu
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tse-Min Lu
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pai-Feng Hsu
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Hsun Huang
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hao-Min Cheng
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chin-Chou Huang
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Hsien Sung
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsin-Bang Leu
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
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Wu YW, Ho SK, Tseng WK, Yeh HI, Leu HB, Yin WH, Lin TH, Chang KC, Wang JH, Wu CC, Chen JW. Potential impacts of high-sensitivity creatine kinase-MB on long-term clinical outcomes in patients with stable coronary heart disease. Sci Rep 2020; 10:5638. [PMID: 32221337 PMCID: PMC7101408 DOI: 10.1038/s41598-020-61894-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/26/2020] [Indexed: 11/30/2022] Open
Abstract
This study aimed to investigate the prognostic value of high-sensitivity creatine kinase-myocardial band or fraction (hsCK-MB) in comparison with other well-established biomarkers including heart type-fatty acid binding protein (H-FABP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with stable coronary heart disease (SCHD). A total of 1,785 patients were enrolled and followed for 36 months. The primary outcome was all-cause mortality. The secondary outcomes included cardiovascular (CV) death, acute myocardial infarction (AMI), angina-related hospitalizations, and hospitalizations for heart failure. The all-cause mortality rate was significantly higher in the high hsCK-MB group compared to the low hsCK-MB group (4.64% vs. 1.88%, p = 0.0026). After adjusting for baseline covariates, there were no significant differences for the secondary outcomes. H-FABP (≥4.226 ng/mL) was the best predictor for all-cause mortality (HR = 2.68, 95% CI = 1.28-5.62, p = 0.009) and CV death (HR = 6.84, 95% CI = 1.89-22.14, p = 0.003). The high NT-proBNP group had a higher AMI-related hospitalization rate (HR = 1.91, 95% CI = 1.00-3.65, p = 0.05). Neither the addition of hsCK-MB to any other markers nor combinations of the three markers improved the prognostic significance of CV outcomes. In conclusion, hsCK-MB was an independent predictor for all-cause mortality but not CV outcomes in patients with SCHD. Combination of hsCK-MB, H-FABP and NT-proBNP failed to improve the prognostic power for all-cause mortality or CV outcomes.
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Affiliation(s)
- Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Sing Kong Ho
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wei-Kung Tseng
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Hung-I Yeh
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
| | - Hsin-Bang Leu
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
- Divison of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Ji-Hung Wang
- Department of Cardiology, Buddhist Tzu-Chi General Hospital, Tzu-Chi University, Hualien, Taiwan
| | - Chau-Chung Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
- Graduate Institute of Medical Education & Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Jaw-Wen Chen
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
- Divison of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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