Abstract 12377: Relation Between Blood Pressure Lowering Therapy and Adverse Cardiovascular Events in Hypertensive Patients With Coronary Artery Disease: The Hij-create Sub-study
Purpose: To explore the optimal systolic blood pressure target in hypertensive patients with coronary artery disease (CAD) in the substudy of the HIJ-CREATE trial.
Methods: HIJ-CREATE was a multicenter, prospective, randomized, controlled study that compared the effects of candesartan-based therapy with those of non-ARB-based standard therapy on MACE in 2,049 hypertensive patients with angiographically documented CAD. In the present study, titration of antihypertensive agents was performed to reach the target blood pressure (BP) of <130/85 mmHg. The primary endpoint was the time to first major adverse cardiac events (MACE). Incidence of endpoint events in addition to biochemistry tests and office BP was determined during the scheduled 6, 12, 24, 36, 48, and 60 month visits. Achieved BP were defined as the mean value of systolic BP in patients who did not meet with MACE and the mean value of systolic BP prior to MACE in those who met with MACE during follow-up.
Results: During a median follow-up of 4.2 years (follow-up rate of 99.6%), the primary outcome occurred in 552 patients (26.9%). The participants were divided into equal quartiles based on the mean systolic BP during follow-up. The relationships between achieved systolic BP and the incidence of MACE did not follow J-shaped in entire group (Figure). These relationships were observed in all age groups (Figure).
Conclusions: The present study suggests that the excessive BP lowering regimen of the contemporary era causes no harm even in high risk population. Nonetheless, along with BP lowering therapy, the establishment of an optimal management strategy for hypertensive patients with CAD is essential.
- © 2012 by American Heart Association, Inc.