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Diastolic Blood Pressure in Coronary Artery Disease
- Thomas Weber, MD;
- Johann Auer, MD;
- Bernd Eber, MD; and
- Michael F. O'Rourke, MD
- From Klinikum Wels, Wels, Austria, and St. Vincent's Clinic, Sydney, Australia.
TO THE EDITOR:
Messerli and colleagues (1) provide new insights into the J-curve discussion in hypertensive patients with coronary artery disease (CAD). Briefly, they observed an increase in all-cause mortality and myocardial infarctions with lower diastolic blood pressure in patients from the International Verapamil-Trandolapril Study (INVEST) (2), hypertensive patients with CAD, who were treated with a verapamil sustained-release–based or atenolol-based strategy. The authors mention impaired coronary perfusion, increased pulse pressure and arterial stiffness, and underlying chronic illness as possible pathophysiologic mechanisms.
Clearly, we cannot speculate on the latter mechanism, but we would like to …
