Systolic Blood Pressure and Subjective Well-Being in Patients with Coronary Artery Disease

Background: Limited information exists regarding the association between subjective well-being (SWB) and systolic blood pressure (SBP) among hypertensive patients with coronary artery disease (CAD). Hypothesis: We tested the hypothesis that there is an association between SBP and SWB. Methods: We studied 22576 hypertensive CAD patients >= 50 years old in the INternational VErapamil SR-Trandolapril Study (INVEST), a randomized, blinded-endpoint trial of antihypertensive therapy in stable CAD patients. At each study visit, patients rated their SWB in the previous 4 weeks as "excellent," "good," "fair," or "poor" prior to SBP recordings. The outcome measure was SWB of "fair" or "poor." A longitudinal analysis using generalized estimating equations was performed to assess the association between SBP and odds of reporting fair/poor SWB, controlling for baseline SWB of fair/poor and angina reported during the study. Results: Patients with higher SBP had higher odds of reporting fair/poor SWB. Specifically, compared with patients with SBP Of >= 120, patients with SBP >0 - >= 160 and >160 had about 90% and 2.5 times greater odds of feeling fair/poor, respectively (adjusted odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.81-2.00 and adjusted OR: 2.53, 95% Cl: 2.41-2.66). Those who reported angina in the 4 weeks prior to a protocol visit had 2.2 times greater odds of reporting fair/poor SWB (adjusted OR: 2.2, 95% Cl: 2.13-2.27). Female gender, black race, history of smoking, diabetes, myocardial infarction, stroke, and cancer also increased the odds of reporting fair/poor SWB. Conclusions: Among hypertensive CAD patients, higher on-treatment SBP is associated with greater odds of fair/poor SWB during follow-up.