{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T02:50:02Z","timestamp":1775098202892,"version":"3.50.1"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"17","license":[{"start":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T00:00:00Z","timestamp":1583107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004807","name":"DFG","doi-asserted-by":"publisher","award":["TTR 219, S-01, M-03, M-05"],"award-info":[{"award-number":["TTR 219, S-01, M-03, M-05"]}],"id":[{"id":"10.13039\/100004807","id-type":"DOI","asserted-by":"publisher"}]},{"name":"French National Research Agency Fighting Heart Failure","award":["ANR-15-RHU-0004"],"award-info":[{"award-number":["ANR-15-RHU-0004"]}]},{"name":"French PIA project \u00abLorraine Universit\u00e9 d\u2019Excellence \u00bb GEENAGE"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The described association of low diastolic blood pressure (DBP) with increased cardiovascular outcomes could be due to reduced coronary perfusion or is simply due to reverse causation. If DBP is physiologically relevant, coronary reperfusion after myocardial infarction (MI) might influence DBP\u2013risk association.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>The relation of achieved DBP with cardiovascular death or cardiovascular hospitalization, cardiovascular death, and all-cause death was explored in 5929 patients after acute myocardial infarction (AMI) with impaired left ventricular function, signs and symptoms of heart failure, or diabetes in the EPHESUS trial according to their reperfusion status. Cox regression models were used to assess the impact of reperfusion status on the association of DBP and systolic blood pressure (SBP) with outcomes in an adjusted fashion. In patients without reperfusion, lower DBP &amp;lt;70\u2009mmHg was associated with increased risk for all-cause death [adjusted hazard ratios (HRs) 1.80, 95% confidence interval (CI) 1.41\u20132.30; P\u2009&amp;lt;\u20090.001], cardiovascular death (HR 1.70, 95% CI 1.3\u20133.22; P\u2009&amp;lt;\u20090.001), cardiovascular death or cardiovascular hospitalization (HR 1.54, 95% CI 1.26\u20131.87; P\u2009&amp;lt;\u20090.001). In patients with reperfusion, the risk increase at low DBP was not observed. At low SBP, risk increased independently of reperfusion. A sensitivity analysis in the subgroup of patients with optimal SBP of 120\u2013130\u2009mmHg showed again risk reduction of reperfusion at low DBP. Adding the treatment allocation to eplerenone or placebo into the models had no effects on the results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients after AMIs with a low DBP had an increased risk, which was sensitive to reperfusion therapy. Low blood pressure after MI identifies in patients with particular higher risk. These data support the hypothesis that low DBP in patients with stenotic coronary lesions is associated with risk, potentially involving coronary perfusion pressure and the recommendations provided by guidelines suggesting lower DBP boundaries for these high-risk patients.<\/jats:p>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehaa132","type":"journal-article","created":{"date-parts":[[2020,2,20]],"date-time":"2020-02-20T12:49:52Z","timestamp":1582202992000},"page":"1673-1683","source":"Crossref","is-referenced-by-count":57,"title":["Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2976-2514","authenticated-orcid":false,"given":"Michael","family":"B\u00f6hm","sequence":"first","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin III, Universit\u00e4tsklinikum des Saarlandes, Saarland University, Kardiologie, Angiologie und Internistische Intensivmedizin , Kirrberger Str. 1, 66421 Homburg\/Saar, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2304-6138","authenticated-orcid":false,"given":"Jo\u00e3o Pedro","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Centre d\u2018Investigation Clinique Plurith\u00e9matique Pierre Drouin\u2014INSERM CHU de Nancy , Nancy, France"},{"name":"Universit\u00e9 de Lorraine, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network , Nancy, France"}]},{"given":"Felix","family":"Mahfoud","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin III, Universit\u00e4tsklinikum des Saarlandes, Saarland University, Kardiologie, Angiologie und Internistische Intensivmedizin , Kirrberger Str. 1, 66421 Homburg\/Saar, Germany"}]},{"given":"Kevin","family":"Duarte","sequence":"additional","affiliation":[{"name":"Centre d\u2018Investigation Clinique Plurith\u00e9matique Pierre Drouin\u2014INSERM CHU de Nancy , Nancy, France"},{"name":"Universit\u00e9 de Lorraine, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network , Nancy, France"}]},{"given":"Bertram","family":"Pitt","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, University of Michigan , 3910 Taubman, 1500 E Medical Center, Ann Arbor, MI 48109-066, USA"}]},{"given":"Faiez","family":"Zannad","sequence":"additional","affiliation":[{"name":"Centre d\u2018Investigation Clinique Plurith\u00e9matique Pierre Drouin\u2014INSERM CHU de Nancy , Nancy, France"},{"name":"Universit\u00e9 de Lorraine, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network , Nancy, France"}]},{"given":"Patrick","family":"Rossignol","sequence":"additional","affiliation":[{"name":"Centre d\u2018Investigation Clinique Plurith\u00e9matique Pierre Drouin\u2014INSERM CHU de Nancy , Nancy, France"},{"name":"Universit\u00e9 de Lorraine, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network , Nancy, France"}]}],"member":"286","published-online":{"date-parts":[[2020,3,2]]},"reference":[{"key":"2022101908163221000_ehaa132-B1","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1016\/j.jacc.2017.11.006","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2022101908163221000_ehaa132-B2","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1093\/eurheartj\/ehy339","article-title":"2018 ESC\/ESH Guidelines for the management of arterial hypertension","volume":"39","author":"Williams","year":"2018","journal-title":"Eur Heart J"},{"key":"2022101908163221000_ehaa132-B3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1161\/HYPERTENSIONAHA.114.04581","article-title":"Does low diastolic blood pressure contribute to the risk of recurrent hypertensive cardiovascular disease events? 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