One-Year Systolic Blood Pressure and Subsequent Cardiovascular Outcomes After Acute Coronary Syndrome: Insights from a Swiss Prospective Cohort.

Aims

Current guidelines recommend targeting systolic blood pressure (SBP) below 130 mmHg in patients at high cardiovascular risk, including after acute coronary syndrome (ACS), although evidence specific to the post-ACS setting remains limited. We evaluated the prognostic value of SBP measured 1 year after ACS on subsequent cardiovascular outcomes.

Methods

The ELIPS cohort prospectively enrolled ACS patients across four Swiss tertiary-care centers (2009-2017). Patients alive at 1 year with available SBP measurements were included. The association between SBP at 1 year and 3-point major adverse cardiovascular events (MACE; cardiovascular death, non-fatal stroke/transient ischemic attack, or non-fatal myocardial infarction) was modeled using restricted cubic splines, adjusted for age, sex, renal function, cardiovascular risk factors, index-event type, coronary revascularization, cardiac rehabilitation, heart-failure history, and antihypertensive medication classes.

Results

Among 2,074 patients (age 63±12 years; 82% male; 53% STEMI), 229 MACE events occurred over a median follow-up of 4.0 years (2.7 per 100 patient-years). The SBP-MACE relationship was nonlinear and J-shaped (P-non-linearity=0.007), with lowest risk between ∼130 and 140 mmHg (formally estimated nadir 138 mmHg [95%CI 116-152]). Above 140 mmHg, each 5-mmHg increase was associated with a borderline increase in MACE risk (adjusted HR 1.08; 95%CI 1.00-1.17). The pattern was broadly consistent across sex, age and hypertension status, with a possible interaction with diabetes that could not be excluded (P-interaction=0.08).

Conclusions

In this large, predominantly male, well-characterized post-ACS cohort, SBP measured 1 year after ACS showed a J-shaped association with cardiovascular risk, with lowest risk at 130-140 mmHg.