Aggressively Lowering Blood Pressure May Stop, Even Reverse Coronary Artery Disease, Cleveland Clinic Study Shows

Research Appears in Aug. 15 Issue of the Journal of the American College of Cardiology

Decreasing blood pressure levels in patients with coronary artery disease may be as important as administering cholesterol-lowering treatment, according to a Cleveland Clinic study.

The study appears in the Aug. 15, 2006 issue of the Journal of the American College of Cardiology and suggests that blood pressure levels currently recommended for patients with coronary artery disease are not low enough to for optimal control or reversal of coronary artery disease.

“Our results have important implications,” said Ilke Sipahi, M.D., a cardiologist at Cleveland Clinic. “They indicate that patients with coronary artery disease, such as those with previous heart attacks, could benefit from more aggressive lowering of their blood pressure, much like aggressive cholesterol management.”

The study also is the subject of a journal editorial that commends the researchers for studying the impact of different blood pressure levels on heart disease, given that most blood pressure trials have focused on comparing specific drugs rather than different target blood pressure levels.

High blood pressure is a prevalent condition known to cause heart disease, the most common cause of death in the United States and many other developed countries. Despite this, the optimal blood pressure needed to control heart disease is unknown. Official recommendations advise keeping systolic blood pressure (top number) below 140 mm Hg and diastolic blood pressure (bottom number) below 90mm Hg, regardless of whether a patient has heart disease.

Cleveland Clinic researchers aimed to identify the optimal blood pressure level for controlling heart disease. They began by measuring the amount of plaque found in the arteries of 274 patients with coronary artery disease, using high-resolution intravascular ultrasound. This required the insertion of tiny ultrasonic transducers in the coronary arteries to provide a baseline examination.

The patients’ blood pressures then were taken periodically for two years, at which point another intravascular ultrasound was performed to measure the change in plaque size. The researchers found that patients with an average blood pressure level above 140 mm Hg systolic or 90 mm Hg diastolic experienced a significant increase in the amount of plaque in their arteries.

In turn, patients with blood pressure levels between 120-139 systolic and 80-90 diastolic saw no change in the amount of plaque. Strikingly, patients with systolic pressure of less than 120 and diastolic pressure of less than 80 mm Hg did better than the other two groups and showed signs of reversal of coronary disease, the researchers report.

The study on blood pressure and the progression of coronary artery disease is one of four Cleveland Clinic studies highlighted in the Aug. 15, 2006 issue of the Journal of the American College of Cardiology. The others pertain to the impairment of HDL, or good cholesterol, by saturated fat; the effects of cocaine on Taser-induced ventricular fibrillation; and the use of advanced CT scanning to monitor heart transplant patients for recurrent heart disease.

Cleveland Clinic, located in Cleveland, Ohio, is a not-for-profit multispecialty academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Approximately 1,500 full-time salaried physicians at Cleveland Clinic and Cleveland Clinic Florida represent more than 100 medical specialties and subspecialties. In 2005, there were 2.9 million outpatient visits to Cleveland Clinic. Patients came for treatment from every state and from more than 80 countries. There were nearly 54,000 hospital admissions to Cleveland Clinic in 2005. Cleveland Clinic’s Web site address is www.clevelandclinic.org.