Blood pressure reduction in stable angina by nifedipine was related to stroke and heart failure reduction but not to coronary interventions.
OBJECTIVE
Whether blood pressure (BP) reduction is a necessary prerequisite for cardiovascular risk reduction or an epiphenomenon has not been definitively established. We used an innovative analytic method to address this question.


METHODS
For 7,287 participants in a stable angina trial comparing long-acting nifedipine to placebo, we estimated the BP response after 2 weeks of treatment corrected for regression-to-the mean, and then related the latter and assigned treatment to subsequent cardiovascular outcomes.


RESULTS
Subsequent stroke and heart failure was strongly related to 2-week corrected systolic BP response, but coronary angiography and bypass surgery was not. Adjustment for the 2-week corrected systolic BP response changed nifedipine effect estimates (relative to placebo) for subsequent stroke from 28% (P=0.04) to 21% (P=0.13) risk reduction, and for heart failure from 30% (P=0.02) to 21% (P=0.11) risk reduction; but did not alter the effect estimates for coronary angiography (27% reduction, P<0.001), and coronary bypass surgery (22% reduction, P=0.002).


CONCLUSIONS
The stroke and heart failure risk reduction by nifedipine GITS in patients with stable angina can be attributed partly to its BP lowering effect, whereas effects on coronary procedures are likely to be related almost entirely to its antianginal effects.
Lubsen
Jacobus
J
SOCAR Research, PO Box 2564, CH-1260 Nyon, Switzerland. jlubsen@compuserve.com
Vokó
Zoltán
Z
Poole-Wilson
Philip A
PA
Kirwan
Bridget-Anne
BA
de Brouwer
Sophie
S
D000787:Angina Pectoris / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D002303:Cardiac Output, Low / Q000209:etiology / Q000517:prevention & control; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
D002121:Calcium Channel Blockers; D009543:Nifedipine