Abstract 12580: Intensive Lipid Lowering with Atorvastatin in Patients with Treatment Resistant Hypertension: An Analysis from the Treating to New Targets (TNT) Trial
Background: Patients with resistant hypertension (defined as blood pressure >140 mm Hg despite 3 antihypertensive agents or <140 mm Hg on 4 or more agents) are at high risk for adverse cardiovascular events. New therapies including catheter based radiofrequency ablation of the renal sympathetic nerves are being tested for this condition. However, if intensive lipid lowering is beneficial in this high risk cohort is not known.
Methods: We evaluated 10,001 patients, with CAD and a LDL cholesterol level <130 mg/dL, randomized to atorvastatin (AT) 80 mg (intensive) vs. 10 mg (standard), enrolled in the TNT trial. Subjects were followed up at 12 weeks, 6, 9 and 12 months and every 6 months thereafter for a median duration of 4.9 years. Primary outcome was major cardiovascular events (composite of nonfatal MI, fatal CHD, resuscitated cardiac arrest, and stroke). Between treatment differences were assessed using a Cox Proportional Hazards model.
Results: Among the 10,001 patients in the trial, 1112 (11.1%) patients had treatment resistant hypertension. Intensive lipid lowering therapy was associated with a signficant reduction in the risk of primary outcome, CHD death, and coronary revascularization, with a trend (P=0.05) towards reduction in all-cause mortality when compared with standard therapy (Figure) in subjects with treatment resistant hypertension.
Conclusions: In subjects with coronary artery disease and treatment resistant hypertension, intensive lipid lowering with atorvastatin is associated with a significant reduction in cardiovascular events.
- © 2012 by American Heart Association, Inc.