One-Year Blood Pressure Shows J-Shaped Association With Cardiovascular Risk After ACS

Guidelines recommend systolic blood pressure (SBP) below 130 mmHg for patients at high cardiovascular risk, although evidence specific to acute coronary syndrome (ACS) remains limited. The prospective ELIPS cohort enrolled patients at four Swiss tertiary-care centers during 2009–2017. This analysis included 2,074 patients alive at one year with available SBP measurements; mean age was 63 years, 82% were male, and 53% had STEMI. The endpoint was cardiovascular death, nonfatal stroke or transient ischemic attack, or nonfatal myocardial infarction.

During a median follow-up of 4.0 years, 229 major adverse cardiovascular events occurred, corresponding to 2.7 per 100 patient-years. After adjustment for demographic and clinical factors and antihypertensive medication classes, the SBP–event relationship was J-shaped (P for nonlinearity=0.007). Risk was lowest around 130–140 mmHg, with an estimated nadir of 138 mmHg (95% CI 116–152). Above 140 mmHg, each 5-mmHg increase was associated with a borderline increase in risk (adjusted HR 1.08; 95% CI 1.00–1.17).

The pattern was broadly consistent across sex, age, and hypertension status. These observational associations cannot establish whether changing BP targets would improve outcomes. The predominantly male population, restriction to one-year survivors, and wide confidence interval around the nadir limit interpretation. Only the abstract was available for assessment.