OBJECTIVES: We sought to determine predictors for adverse outcomes in hypertensive patients with coronary artery disease (CAD). BACKGROUND: Factors leading to adverse outcomes in hypertensive patients with CAD are poorly understood. The INternational VErapamil-trandolapril STudy (INVEST) compared outcomes in hypertensive patients with CAD that were assigned randomly to either a verapamil sustained-release (SR)- or an atenolol-based strategy for blood pressure (BP) control. Trandolapril and hydrochlorothiazide were used as added agents. During follow-up (61,835 patient-years), BP control and the primary outcome (death, nonfatal myocardial infarction, and nonfatal stroke) were not different between strategies. METHODS: We investigated risk for adverse outcome associated with baseline factors, follow-up BP, and drug treatments using Cox modeling. RESULTS:Previous heart failure (adjusted hazard ratio [HR] 1.96), as well as diabetes (HR 1.77), increased age (HR 1.63), U.S. residency (HR 1.61), renal impairment (HR 1.50), stroke/transient ischemic attack (HR 1.43), smoking (HR 1.41), myocardial infarction (HR 1.34), peripheral vascular disease (HR 1.27), and revascularization (HR 1.15) predicted increased risk. Follow-up systolic BP <140 mm Hg or diastolic BP <90 mm Hg (HRs 0.82 or 0.70, respectively) and trandolapril with verapamil SR (HRs 0.78 and 0.79) were associated with reduced risk. CONCLUSIONS: In hypertensive patients with CAD, increased risk for adverse outcomes was associated with conditions related to the severity of CAD and diminished left ventricular function. Lower follow-up BP and addition of trandolapril to verapamil SR each were associated with reduced risk.
RCT Entities:
OBJECTIVES: We sought to determine predictors for adverse outcomes in hypertensivepatients with coronary artery disease (CAD). BACKGROUND: Factors leading to adverse outcomes in hypertensivepatients with CAD are poorly understood. The INternational VErapamil-trandolapril STudy (INVEST) compared outcomes in hypertensivepatients with CAD that were assigned randomly to either a verapamil sustained-release (SR)- or an atenolol-based strategy for blood pressure (BP) control. Trandolapril and hydrochlorothiazide were used as added agents. During follow-up (61,835 patient-years), BP control and the primary outcome (death, nonfatal myocardial infarction, and nonfatal stroke) were not different between strategies. METHODS: We investigated risk for adverse outcome associated with baseline factors, follow-up BP, and drug treatments using Cox modeling. RESULTS: Previous heart failure (adjusted hazard ratio [HR] 1.96), as well as diabetes (HR 1.77), increased age (HR 1.63), U.S. residency (HR 1.61), renal impairment (HR 1.50), stroke/transient ischemic attack (HR 1.43), smoking (HR 1.41), myocardial infarction (HR 1.34), peripheral vascular disease (HR 1.27), and revascularization (HR 1.15) predicted increased risk. Follow-up systolic BP <140 mm Hg or diastolic BP <90 mm Hg (HRs 0.82 or 0.70, respectively) and trandolapril with verapamil SR (HRs 0.78 and 0.79) were associated with reduced risk. CONCLUSIONS: In hypertensivepatients with CAD, increased risk for adverse outcomes was associated with conditions related to the severity of CAD and diminished left ventricular function. Lower follow-up BP and addition of trandolapril to verapamil SR each were associated with reduced risk.
Authors: Eric S Ketchum; Kenneth Dickstein; John Kjekshus; Bertram Pitt; Meagan F Wong; David T Linker; Wayne C Levy Journal: Eur Heart J Acute Cardiovasc Care Date: 2013-09-11
Authors: Phillip D Levy; Robina Josiah Willock; Michael Burla; Aaron Brody; James Mahn; Alexander Marinica; Samar A Nasser; John M Flack Journal: J Am Soc Hypertens Date: 2016-10-28
Authors: Yuxin Niu; Yan Gong; Taimour Y Langaee; Heather M Davis; Hazem Elewa; Amber L Beitelshees; James I Moss; Rhonda M Cooper-Dehoff; Carl J Pepine; Julie A Johnson Journal: Circ Cardiovasc Genet Date: 2010-12
Authors: Amber L Beitelshees; Yan Gong; Danxin Wang; Nicholas J Schork; Rhonda M Cooper-Dehoff; Taimour Y Langaee; Mark D Shriver; Wolfgang Sadee; Harm J Knot; Carl J Pepine; Julie A Johnson Journal: Pharmacogenet Genomics Date: 2007-09 Impact factor: 2.089