Predictors of adverse outcome among patients with hypertension and coronary artery disease.
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.
Pepine
Carl J
CJ
Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida 32610-0277, USA. pepincj@medicine.ufl.edu
Kowey
Peter R
PR
Kupfer
Stuart
S
Kolloch
Rainer E
RE
Benetos
Athanase
A
Mancia
Giuseppe
G
Coca
Antonio
A
Cooper-DeHoff
Rhonda M
RM
Handberg
Eileen
E
Gaxiola
Efrain
E
Sleight
Peter
P
Conti
C Richard
CR
Hewkin
Ann C
AC
Tavazzi
Luigi
L
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
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D007211:Indoles; C052035:trandolapril; D001262:Atenolol; D014700:Verapamil