Abstract 1075: Incident or Continued Angina During Hypertension Treatment is Associated With Increased Risk of Death, MI, or Stroke Among Patients With Known CAD: A Substudy of The INternational VErapamil/Trandolapril STudy (INVEST)
Introduction: To assess the impact of incident angina pectoris on clinical outcomes in a trial of two different antihypertensive treatment strategies.
Methods: Clinically stable outpatients with CAD (n=22,576) were randomly assigned to either a beta blocker (atenolol/HCTZ) or calcium antagonist (verapamil-SR/trandolapril) based hypertension treatment strategy and followed for first occurrence of death, nonfatal MI, or nonfatal stroke (primary outcome, PO). Patients were categorized according to presence or absence of angina at baseline and during follow-up. This prespecified analysis was performed to assess the impact of baseline and incident angina on adverse outcomes during follow up.
Results: The rate of the PO as well as BP control (>70% were <140/90 mmHg), were not significantly different comparing treatment strategies as reported previously. Of 7,531 patients without angina at baseline, the incidence of angina during follow-up was only 3.7%. Patients with incident angina had the highest rate of the PO while those with resolved angina had the lowest rate (Figure⇓). Multivariate analysis of the entire INVEST population demonstrated that as a combined group, having either incident or continued angina was an independent risk factor for the PO (adjusted HR 1.14, 95% CI 1.01–1.28).
Conclusions: Among clinically stable ambulatory hypertensive patients with CAD who achieved excellent BP control, angina incidence rates are very low. Neither a beta blocker nor calcium antagonist-based treatment strategy significantly influences the rate of death, stroke, or MI. However, the presence of angina, either incident or continued, significantly impacted the rate of the PO.