Systolic blood pressure, heart rate, and outcomes in patients with coronary disease and heart failure.

Aims: Data regarding the optimal systolic blood pressure (SBP) and heart rate (HR) for coronary artery disease (CAD) patients with hypertension and a history of heart failure (HF) are limited. Accordingly, using data from a large clinical trial, we investigated the association between SBP and heart rate and subsequent adverse outcomes in CAD patients with a history of HF, and we aimed to better understand how pre-existing HF impacts outcomes among patients with CAD.

Methods And Results: Among 22 576 CAD patients enrolled in the INternational VErapamil SR-Trandolapril STudy (INVEST), 1256 were identified with a history of physician-diagnosed HF New York Heart Association (NYHA) Class 1-3 at entry. The primary outcome was the first occurrence of all-cause death, myocardial infarction (MI), or stroke. Cox proportional-hazards models adjusted for pre-specified covariates were constructed to estimate risk among the HF cohort compared with a case-matched sample from the non-HF cohort. At a mean 2.5 years' follow-up, those with prior HF had a higher risk of the primary outcome (hazard ratio (HR) 2.55, 95% confidence interval 2.30-2.83, P < 0.0001). Among those with history of HF, a low (<120 mmHg) or high (>140 mmHg) SBP and heart rate ≥ 85 b.p.m. were associated with increased risk for adverse outcomes, which persisted after covariate adjustment.

Conclusions: In patients with CAD, a physician diagnosis of HF at baseline portended a higher risk for death, MI, or stroke than in those without an HF history. Achieving SBP of 120-140 mmHg and heart rate < 85 b.p.m. was associated with a better outcome in patients with known HF and CAD.