can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous?
GROUND: Because coronary perfusion occurs mainly during diastole, patients with coronary artery disease (CAD) could be at increased risk for coronary events if diastolic pressure falls below critical levels. OBJECTIVE: To determine whether low blood pressure could be associated with excess mortality and morbidity in this population. DESIGN: A secondary analysis of data from the International Verapamil-Trandolapril Study (INVEST), which was conducted from September 1997 to February 2003. SETTING: 862 sites in 14 countries. PATIENTS: 22 576 patients with hypertension and CAD. Interventions: Patients from INVEST were randomly assigned to a verapamil sustained-release- or atenolol-based strategy; blood pressure control and outcomes were equivalent. MEASUREMENTS: An unadjusted quadratic proportional hazards model was used to evaluate the relationship between average on-treatment blood pressure and risk for the primary outcome (all-cause death, nonfatal stroke, and nonfatal myocardial infarc
