Abstract 12504: Relation between Blood Pressure Lowering Therapy and Cardiovascular Events in Hypertensive Patients With Coronary Artery Disease and Chronic Kidney Disease -The HIJ-CREATE Sub-study
Purpose: To explore the optimal blood pressure target in hypertensive patients with coronary artery disease (CAD) and chronic kidney disease (CKD) in the substudy of the HIJ-CREATE trial.
Methods: HIJ-CREATE was a prospective, randomized trial that compared the effects of candesartan-based therapy with those of non-ARB standard therapy on MACE in 2049 hypertensive patients with CAD. Among them, CKD defined as a decrease in creatinine clearance calculated using the abbreviated MDRD formula to ≤ 60 ml/min. was recognized in 1002 patients. 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 MACEs 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 304 patients (30.3%). There was a higher incidence of MACE in the CKD patients than in the non-CKD patients (HR=1.44, 95% CI 1.19-1.74, p=0.001). The participants with CKD were divided into equal quartiles based on the mean systolic and diastolic BP during follow-up. The relationships between achieved systolic BP and the incidence of MACE did not follow J-shaped in entire group (Figure).
Conclusions: Although non-attainment of BP lowering regimen correlates with unfavorable outcomes, the results of the present study did not confirm “the lower, the better” theory in BP lowering therapy for hypertensive patients with CAD and CKD. Establishment of an optimal management strategy for hypertensive patients with CAD and CKD is essential.
- © 2013 by American Heart Association, Inc.