HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.09.031v1 47/3/547    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (16) Citing Articles via Google Scholar Google Scholar Articles by Pepine, C. J. Search for Related Content PubMed PubMed Citation Articles by Pepine, C. J.

CLINICAL RESEARCH: CHRONIC CORONARY ARTERY DISEASE

Predictors of Adverse Outcome Among Patients With Hypertension and Coronary Artery Disease

Carl J. Pepine, MD, MACC^_*,_*, Peter R. Kowey, MD, FACC, Stuart Kupfer, MD, Rainer E. Kolloch, MD, Athanase Benetos, MD, PhD^||, Giuseppe Mancia, MD, PhD^¶, Antonio Coca, MD^#, Rhonda M. Cooper-DeHoff, PharmD^_*, Eileen Handberg, PhD^_*, Efrain Gaxiola, MD, FACC^_**, Peter Sleight, MD, FACC, C. Richard Conti, MD, MACC^_*, Ann C. Hewkin, MSc, Luigi Tavazzi, MD, FACC for the INVEST Investigators

^_* Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
Lankenau Hospital, Wynnewood, Pennsylvania
Abbott, Abbott Park, Illinois
University of Munster School of Medicine, Bielefeld, Germany
^|| University of Nancy, Vandoeuvre-les-Nancy, France
^¶ Department of Medicine, University of Milano-Bicocca, Milano, Italy
^# Hospital Clinic, Barcelona, Spain
^_** Instituto Cardiovascular de Guadalajara, Guadalajara, Mexico
University of Oxford, Oxford, United Kingdom
Prioario Division of Cardiology, Policlinico San Matteo, Pavia, Italy.

Manuscript received May 28, 2004; revised manuscript received September 2, 2005, accepted September 12, 2005.

^_* Reprint requests and correspondence: Dr. Carl J. Pepine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road, Gainesville, Florida 32610-0277. (Email: pepincj{at}medicine.ufl.edu).

OBJECTIVES: 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.

Abbreviations and Acronyms   BMI = body mass index   BP = blood pressure   CAD = coronary artery disease   CI = confidence interval   DBP = diastolic blood pressure   HCTZ = hydrochlorothiazide   HR = hazard ratio   INVEST = INternational VErapamil-trandolapril STudy   MI = myocardial infarction   SBP = systolic blood pressure   SR = sustained release

This article has been cited by other articles:

				P. M. Ho, D. J. Magid, S. M. Shetterly, K. L. Olson, P. N. Peterson, F. A. Masoudi, and J. S. Rumsfeld Importance of Therapy Intensification and Medication Nonadherence for Blood Pressure Control in Patients With Coronary Disease Arch Intern Med, February 11, 2008; 168(3): 271 - 276. [Abstract] [Full Text] [PDF]

				G. Mancia, F. Messerli, G. Bakris, Q. Zhou, A. Champion, and C. J. Pepine Blood Pressure Control and Improved Cardiovascular Outcomes in the International Verapamil SR-Trandolapril Study Hypertension, August 1, 2007; 50(2): 299 - 305. [Abstract] [Full Text] [PDF]

				D. A. Sica Hypertension Treatment: How Important Is Consistency of Effect? Hypertension, August 1, 2007; 50(2): 287 - 288. [Full Text] [PDF]

				Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF]