Abstract 3704: Association of “J-Shaped” Curves and Coronary Revascularization Status: A Substudy of the International Verapamil SR-Trandolapril Study (INVEST)
BACKGROUND Our understanding of the expanding population of coronary artery disease (CAD) patients (pts) with hypertension (HTN) and prior coronary revascularization is limited, including information on the relationship between risk for primary outcomes (PO: death, non-fatal myocardial infarction and non-fatal stroke) and blood pressure (BP).
METHODS Secondary analysis of data from the International Verapamil-SR-Trandolapril Study (INVEST): Characteristics of clinically stable CAD pts with HTN and prior revascularization (n=6166) compared to those without prior revascularization (n=16,410). Since there were no differences in BP control (>70% with <140/<90 mmHg) comparing the randomized treatment strategies, the entire cohort was analyzed.
RESULTS After 61,835 pt-years, 2269 pts suffered a PO and the frequency and adjusted hazard ratios for these events were related to on-treatment systolic and diastolic (D) BP in a “J-shaped” pattern independent of revascularization status. For pts with prior revascularization, the relative risk for a PO at low DBP, compared to normal DBP, was notably less compared to that for pts without prior revascularization. Also, revascularization that included percutaneous coronary intervention (PCI) was associated with an increase in relative risk for PO at lower DBP, compared to normal DBP (see figure⇓). Conversely, revascularization that included coronary artery bypass grafting was associated with a decrease at lower DBP, compared to normal DBP.
CONCLUSIONS Optimal management of HTN in CAD pts must continue to focus on BP control. For HTN CAD pts with a history of revascularization including PCI, excessively low DBP should be avoided.