Effects of cardiac complications on cardiovascular events in Japanese high-risk hypertensive patients: subanalysis of the CASE-J trial.
BACKGROUND
The Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial compared the effects of candesartan and amlodipine on cardiovascular events in Japanese high-risk hypertensive patients. The present study aimed to clarify the effect of cardiac complications on cardiovascular events in patients enrolled in CASE-J.


RESULTS
Cardiac complications were defined as left ventricular hypertrophy (LVH) and ischemic heart disease (IHD). The primary endpoint was a composite of sudden death, cerebrovascular, cardiac, renal and vascular events. The study group was divided into 2,030 and 2,673 patients with and without cardiac complications. During 3.2 follow-up years, cardiovascular events occurred for a rate of 13.6 per 1000 patient-years in patients without cardiac complications, and 23.1 per 1000 patient-years in patients with cardiac complications (adjusted hazard ratio (HR): 2.22; P<0.001). Furthermore, LVH was associated with the onset of cerebrovascular events (adjusted HR: 2.38; P<0.001), whereas IHD was associated with the onset of cardiovascular death (adjusted HR: 2.22; P<0.05), especially sudden death and other cardiac events.


CONCLUSIONS
Cardiac complications are independent predictors for cardiovascular events in Japanese high-risk hypertensive patients. In particular, LVH is related to cerebrovascular events and IHD is related to cardiac death and other cardiac events.
Ueshima
Kenji
K
EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan. k_ueshima@pbh.med.kyoto-u.ac.jp
Yasuno
Shinji
S
Oba
Koji
K
Fujimoto
Akira
A
Ogihara
Toshio
T
Saruta
Takao
T
Nakao
Kazuwa
K
D018674:Adrenergic Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D017311:Amlodipine / Q000494:pharmacology / Q000627:therapeutic use; D001562:Benzimidazoles / Q000494:pharmacology / Q000627:therapeutic use; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000208:ethnology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000208:ethnology; D011379:Prognosis; D012307:Risk Factors; D013777:Tetrazoles / Q000494:pharmacology / Q000627:therapeutic use
D018674:Adrenergic Antagonists; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D002121:Calcium Channel Blockers; D013777:Tetrazoles; D017311:Amlodipine; C081643:candesartan