Wednesday, August 16, 2006 (Reuters Health)—The progression of coronary atherosclerosis is lowest for patients with blood pressure below 120/80 mm Hg, according to a report in the August 15th issue of the Journal of the American College of Cardiology.

"We think that now it is the time to discover the optimal standards for blood pressure reduction for patients with coronary disease," Dr. Ilke Sipahi of the Cleveland Clinic Foundation, Ohio told Reuters Health. "It is likely that within the next few years we will realize that we have been treating blood pressure too conservatively."

Dr. Sipahi and colleagues evaluated the effects of normal blood pressure, prehypertension, and hypertension on the progression of coronary atherosclerosis (as measured by intravascular ultrasound) in 274 patients taking part in a clinical trial.

Both mean systolic blood pressure and mean pulse pressure were significant predictors of change in atheroma volume in a multivariable analysis that controlled for lipid levels and other recognized coronary artery disease risk factors.

The increase in adjusted atheroma volume was 12.0 mm³ for hypertensive patients and a non-significant 0.9 mm³ for prehypertensive subjects. Patients with normal blood pressure experienced a decrease in atheroma volume of 4.6 mm³ over the 2-year study.

Patients who moved from prehypertensive to normal blood pressure levels during the study had a decrease in atheroma volume (mean, 6.2 mm³), the researchers note. Patients whose blood pressure remained at prehypertensive levels had a mean 1.5-mm³ increase in atheroma volume.

Thus, said Dr. Sipahi, blood pressure levels below 120/80 mm Hg "are the best to slow progression of atherosclerosis." These normal levels, he added, "were even associated with a strong trend for reversal of coronary disease."

In an accompanying editorial, Drs. Jonathan Tobis and Gregg C. Fonarow of the University of California, Los Angeles note that the findings point to "a critical need to reassess the guidelines for managing blood pressure in patients with coronary artery disease."

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