Lower Systolic Blood Pressure and Cardiovascular Event Risk Stratified by Renal Resistive Index in Hospitalized Cardiovascular Patients: J-VAS Study

Abstract

BACKGROUND The threshold of blood pressure (BP) reduction in cardiovascular patients is debatable due to the J-shaped curve phenomenon, which is particularly observed in patients with increased arterial stiffness. The renal resistive index (RRI) correlates well with systemic arterial stiffness; therefore, we aimed to demonstrate the role of RRI in guiding the choice of optimal BP. METHODS A retrospective analysis of prospectively collected data of the hospitalized cardiovascular patients at Jichi Medical University Hospital. All patients had the RRI measurement performed and were assigned to a higher (RRI ≥ 0.8) or lower RRI group. Each group was subdivided by quartiles of the BP at discharge. The primary endpoints were fatal and nonfatal cardiovascular events, including heart failure, acute coronary syndrome, acute aortic disease, acute arterial occlusion, and stroke. RESULTS The mean follow-up period was 1.9 years (3,365 person-years), n = 1,777 (mean age 64.7 years). There were 252 cardiovascular events occurred, 24.0% and 12.2% in the higher and lower RRI populations, P < 0.001. In the higher RRI group, the lowest systolic BP (SBP) quartile (<105 mm Hg) was a risk factor for cardiovascular events when compared with the highest SBP quartile (≥130 mm Hg; adjusted hazard ratio, 2.42; 95% confidence interval, 1.17–5.03; P = 0.017). A 1 SD decrease of SBP (17.5 mm Hg) was associated with a 25% increase in the risk of cardiovascular events. In the lower RRI group, these associations were not observed. CONCLUSIONS Lower SBP at discharge was associated with a risk of cardiovascular events in the hospitalized cardiovascular patients with RRI ≥ 0.8.

Differential Impact of the Renal Resistive Index on Future Cardiovascular Events in Hospitalized Atherosclerotic Cardiovascular Patients According to Left Ventricular Ejection Fraction ― The Jichi Vascular Hemodynamics in Hospitalized Cardiovascular Patients (J-VAS) Study ―

“…Based on acceptable accuracy and several previous reports that investigated the effects of RRI ≥0.8 on decreased event-free survival in patients with HFpEF 19 and in the elderlies, 20 we used 0.8 as the cut-off point for RRI in the Taking these prior findings into account, we postulated that a high RRI may contribute to poor cardiovascular outcomes in ASCVD patients classified according to LVEF. To test our hypothesis, we used data of patients in the Jichi Vascular Hemodynamics in Hospitalized Cardiovascular Patients (J-VAS) study, 17 which enrolled ASCVD patients with different LVEF values.…”

“…We retrospectively analyzed the data of patients from the J-VAS study, which has been described in detail elsewhere. 17 Briefly, the J-VAS study is a single-center, retrospective cohort study of Japanese adults with cardiovascular diseases who were admitted to the cardiovascular unit of Jichi Medical University Hospital, a tertiary care center in Tochigi, Japan. All patients underwent non-invasive vascular hemodynamic measurements, including clinic blood pressure (BP), cardiac echocardiography, renal and carotid artery Doppler ultrasonography, ankle-brachial index, and arterial pulse wave velocity.…”