title: Angiotensin receptor blocker-based therapy and cardiovascular events in hypertensive patients with coronary artery disease and impaired renal function.
abstract: The aim of this study was to assess the effects of angiotensin receptor blocker (ARB)-based therapy on cardiovascular events in high-risk hypertensive patients with coronary artery disease (CAD) and impaired renal function in post hoc analysis of HIJ-CREATE (Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease). Patients (n=2049) were randomly assigned to candesartan-based or non-ARB treatment arms; 1022 patients (age 70 ± 6 years, 28% female) with impaired renal function, defined as creatinine clearance <60 ml/min at baseline. There was no difference in major adverse cardiac event (MACE), a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke and other cardiovascular events requiring hospitalization between the two arms in patients without impaired renal function. However, there was a lower incidence of MACE in the candesartan-based treatment arm than in the non-ARB treatment arm (HR=0.79, 95% CI 0.63-0.99, p=0.039) in patients with impaired renal function. Among the MACE, candesartan-based treatment reduced hospitalization for unstable angina (HR=0.71, 95% CI 0.52-0.96, p=0.028). Although candesartan-based treatment was not superior to non-ARB treatment in prevention of cardiac mortality, ARB-based therapy may be beneficial in reducing risk of coronary events in hypertensive patients with CAD and impaired renal function.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. mshiga@hij.twmu.ac.jp
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shiga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kasanuki
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Takashi
authors.initials: T
authors.lastname: Honda
authors.forename: Kazuo
authors.initials: K
authors.lastname: Haze
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takagi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kawana
authors.forename: Hideki
authors.initials: H
authors.lastname: Origasa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D003324:Coronary Artery Disease / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications*; D012307:Risk Factors; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan