Abstract 6216: Association of “J-Shaped” Curves and Age: A Substudy of the International Verapamil SR-Trandolapril Study (INVEST)
Our understanding of the expanding population of older patients with coronary artery disease (CAD) and hypertension (HTN) is limited, including information on the relationship between risk for adverse outcomes (death, non-fatal myocardial infarction and non-fatal stroke) and blood pressure (BP). Secondary analysis of data from the International Verapamil-SR-Trandolapril Study (INVEST): Characteristics of clinically stable CAD pts aged ≥50 years with HTN, based upon age in 10-year increments (age <60: N=6,668; 60-<70: N=7,602; 70-<80: N=6,126; ≥80: N=2,180). Since there were no differences in BP control (>70% with <140/<90 mmHg) comparing the randomized treatment strategies, the entire cohort was analyzed. After 61,835 pt-years, 2269 pts suffered an adverse outcome. The adjusted hazard ratios for these events were related to on-treatment systolic (S) and diastolic (D) BP as a “J-shaped” curve for each age group (see figure⇓). For SBP, the J-shaped curve rotated clockwise with increasing age group (i.e.: higher BP was associated with less risk and lower BP was associated with more risk for progressively older age groups). This association with increasing age was not seen for DBP. However, for DBP, the J-shaped curves were steeper for each age group (i.e.: the increased risk associated with both higher and lower DBP was proportionately greater compared to SBP). Optimal management of HTN in older CAD pts should be targeted into specific SBP and DBP ranges based upon pt age. The oldest pts appeared to tolerate a higher SBP better and a lower SBP worse compared to younger pts, and all pts regardless of age had a relatively narrow range of optimal DBPs.