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Low BP a danger in artery disease

Excessive reductions in diastolic blood pressure can have fatal consequences for hypertensive patients with coronary artery disease, a new study reveals.

The researchers, whose study was published in the Annals of Internal Medicine last week, warned that aggressively lowering blood pressure should be avoided in patients with coronary artery disease.

A diastolic BP below 70mmHg substantially increased the risk of deaths or cardiovascular events, the analysis of data from 22,576 patients on the Invest trial showed.

Risk of death, non-fatal stroke or non-fatal myocardial infarction doubled in patients with a diastolic BP between 60 and 70mmHg and tripled for those whose BP was below 60mmHg.

Dr Franz Messerli, director of clinical hypertension at St Luke's-Roosevelt Hospital in New York, said: 'These findings emphasise that hypertensive patients with coronary artery disease and a lower diastolic BP are at increased risk. They suggest caution with excessive lowering of diastolic BP in these patients.'

Dr John Ashcroft, CHD lead for Erewash PCT and a GP in Ilkeston, Derbyshire, said: 'I've always tended to be anxious about lowering diastolic BP with coronary artery disease, and this is going to make me even more anxious. If a patient's diastolic pressure is already in the low 80s I wouldn't want to see it in the 70s.'

But Dr Jonathan Shribman, CHD lead for Daventry and South Northamptonshire PCT, and a GP in Bugbrooke, Nor-thants, said: 'I'd want someone to go back and look at some of the outcome studies to see if there's a similar relationship.'

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