One-Year Systolic Blood Pressure and Subsequent Cardiovascular Outcomes After Acute Coronary Syndrome: Insights from a Swiss Prospective Cohort

AIMS: Current guidelines recommend targeting systolic blood pressure (SBP) below 130 mmHg in patients at high cardiovascular risk, including after acute coronary syndrome (ACS), although evidence specific to the post-ACS setting remains limited. We evaluated the prognostic value of SBP measured 1 year after ACS on subsequent cardiovascular outcomes. METHODS: The ELIPS cohort prospectively enrolled ACS patients across four Swiss tertiary-care centers (2009-2017). Patients alive at 1 year with available SBP measurements were included. The association between SBP at 1 year and 3-point major adverse cardiovascular events (MACE; cardiovascular death, non-fatal stroke/transient ischemic attack, or non-fatal myocardial infarction) was modeled using restricted cubic splines, adjusted for age, sex, renal function, cardiovascular risk factors, index-event type, coronary revascularization, cardiac rehabilitation, heart-failure history, and antihypertensive medication classes. RESULTS: Among 2,074 patients (age 63±12 years; 82% male; 53% STEMI), 229 MACE events occurred over a median follow-up of 4.0 years (2.7 per 100 patient-years). The SBP-MACE relationship was nonlinear and J-shaped (P-non-linearity=0.007), with lowest risk between ∼130 and 140 mmHg (formally estimated nadir 138 mmHg [95%CI 116-152]). Above 140 mmHg, each 5-mmHg increase was associated with a borderline increase in MACE risk (adjusted HR 1.08; 95%CI 1.00-1.17). The pattern was broadly consistent across sex, age and hypertension status, with a possible interaction with diabetes that could not be excluded (P-interaction=0.08). CONCLUSIONS: In this large, predominantly male, well-characterized post-ACS cohort, SBP measured 1 year after ACS showed a J-shaped association with cardiovascular risk, with lowest risk at 130-140 mmHg.