Evaluation of patients referred for possible coronary revascularization among patients with and without a history of hypertension. Swedish Coronary Artery Revascularization/Swedish Council on Technology Assessment in Health Care (SECOR/SBU) Project Group.
Patients with and without a history of hypertension referred for eventual coronary revascularization were compared on the basis of a national survey including previous history, indications for coronary angiography, use of medication, findings at exercise test and cardioangiography, and long-term prognosis. As part of a national study of the appropriateness of coronary revascularization, data were prospectively collected on patients referred for possible coronary revascularization to 7/8 public Swedish heart centers that performed approximately 92% of all bypass operations in Sweden in 1994. The study included 2764 patients of whom 986 (36%) had a history of hypertension. Indications for coronary angiography were similar in patients with and without a history of hypertension. Triple therapy (a combination of beta-blockers, long-acting nitrates and calcium channel-blockers) was more frequently used among patients with hypertension (32.6% as compared with 21.4% among patients without hypertension; p < 0.001). With the exception of ST depression > 6 min after discontinuation of exercise test, which was more frequent among hypertensive patients (30.9% vs 25.7%; p < 0.05), the various indicators of myocardial ischemia were similar in the two groups during exercise. Patients with hypertension had a somewhat lower exercise capacity (mean of 109.6 w) than patients without hypertension (113.7; p < 0.05). The extent of coronary artery disease was more severe among hypertensives (p < 0.001). Overall mortality during the subsequent 21 months was 5.6% for patients with hypertension and 3.1% for patients without hypertension (p < 0.01). This was caused mainly by a difference in cardiovascular mortality (3.9% vs 2.5%; p < 0.05) and cerebrovascular mortality (1.0% vs 0.3%; p < 0.05). Among patients referred for possible coronary revascularization, those with a history of hypertension differed from those without such a history, in that they more frequently had ST depression at exercise test, a lower exercise capacity, more severe coronary artery disease, a higher frequency of triple-therapy use and a higher mortality rate.
Brorson
B
B
The Swedish Council on Technology Assessment in Health Care, Stockholm.
Herlitz
J
J
Werkö
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002423:Cause of Death; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000959:Antihypertensive Agents