High blood pressure is inversely related with the presence and extent of coronary collaterals

Patients with hypertension have an increased case fatality during acute myocardial infarction (MI). Coronary collateral (CC) circulation has been proposed to reduce the risk of death during acute ischaemia. We determined whether and to which degree high blood pressure (BP) affects the presence and extent of CC circulation. A cross-sectional study in 237 patients (84% males), admitted for elective coronary angioplasty between January 1998 and July 2002, was conducted. Collaterals were graded with Rentrop's classification (grade 0 -3). CC presence was defined as Rentrop-grade ≥1. BP was measured twice with an inflatable cuff manometer in seated position. Pulse pressure was calculated by systolic blood pressure (SBP)-diastolic blood pressure (DBP). Mean arterial pressure was calculated by DBP+1/3 × (SBP-DBP). Systolic hypertension was defined by a reading ≥140mmHg. We used logistic regression with adjustment for putative confounders. SBP (odds ratio (OR) 0.86 per 10mmHg; 95% confidence interval (CI) 0.73 -1.00), DBP (OR 0.67 per 10mmHg; 95% CI 0.49 -0.93), mean arterial pressure (OR 0.73 per 10mmHg; 95% CI 0.56 -0.94), systolic hypertension (OR 0.49; 95% CI 0.26 -0.94), and antihypertensive treatment (OR 0.53; 95% CI 0.27 -1.02), each were inversely associated with the presence of CCs. Also, among patients with CCs, there was a graded, significant inverse relation between levels of SBP, levels of pulse pressure, and collateral extent. There is an inverse relationship between BP and the presence and extent of CC circulation in patients with ischaemic heart disease.

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