title: Predictors of adverse outcome among patients with hypertension and coronary artery disease.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida 32610-0277, USA. pepincj@medicine.ufl.edu
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kowey
authors.forename: Stuart
authors.initials: S
authors.lastname: Kupfer
authors.forename: Rainer E
authors.initials: RE
authors.lastname: Kolloch
authors.forename: Athanase
authors.initials: A
authors.lastname: Benetos
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Antonio
authors.initials: A
authors.lastname: Coca
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Cooper-DeHoff
authors.forename: Eileen
authors.initials: E
authors.lastname: Handberg
authors.forename: Efrain
authors.initials: E
authors.lastname: Gaxiola
authors.forename: Peter
authors.initials: P
authors.lastname: Sleight
authors.forename: C Richard
authors.initials: CR
authors.lastname: Conti
authors.forename: Ann C
authors.initials: AC
authors.lastname: Hewkin
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001262:Atenolol / Q000627:therapeutic use; D001794:Blood Pressure; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D007211:Indoles / Q000627:therapeutic use; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D007211:Indoles; C052035:trandolapril; D001262:Atenolol; D014700:Verapamil