Abstract 11945: Prediction Tool for Adverse Events among Patients with Hypertension and Chronic Stable Coronary Artery Disease

Abstract

Introduction: Hypertension (HTN) is highly prevalent among patients with coronary artery disease (CAD). It is difficult to predict risk for adverse outcomes among these complex patients.

Hypothesis: Readily available clinical variables could be developed into a simple-to-use risk score.

Methods: Patients ≥50 years of age with HTN and clinically stable CAD enrolled in the INternational VErapamil-SR/Trandolapril STudy comprised the study cohort. Patients were randomized to either a calcium antagonist or a beta-blocker-based strategy for HTN treatment. The strategies were equivalent for prevention of adverse outcomes; therefore, patients were divided into development (n=18,484) and validation cohorts (n=2,054). Candidate predictor variables were obtained from patients in the development cohort with at least one post-baseline office visit. Cox regression model was used to identify predictors of adverse outcomes; first occurrence of all-cause mortality, nonfatal myocardial infarction (MI), or nonfatal stroke at a mean follow-up of 2.3 years. Hazard ratios of each retained variable were rounded to the nearest integer to construct score weights. The following variables were assigned 2 points each: age ≥65 years, body mass index <20 kg/m², SBP <110 mm Hg, heart failure, prior stroke/transient ischemic attack, diabetes, and chronic kidney disease. The following variables were assigned one point each: heart rate ≥85 beats/minute, SBP ≥140 mm Hg, prior MI, current/prior smoking, and peripheral arterial disease.

Results: The primary outcome occurred in 3.7% of the low-score (≤2) group, 11% of the intermediate-score (3-6) group, and 28% of the high-score (≥7) group (Figure; p for trend < 0.0001). A similar gradation in risk was observed in the validation cohort (p for trend < 0.0001).

Conclusions: Readily available clinical variables from office visits can be easily utilized to stratify ambulatory patients with HTN and chronic stable CAD into useful risk categories.