Abstract 12514: Prognostic Significance of Visit-to-visit Variability and Systolic Blood Pressure Control in Hypertensive Patients With Coronary Artery Disease -the HIJ-CREATE Sub-study
Purpose: Although visit-to-visit variability in systolic blood pressure (sys-BP) is strong predictors of stroke, the impact on subsequent major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) remains unclear. To evaluate the prognostic significance of visit-to-visit variability in sys-BP in hypertensive patients with CAD.
Methods: HIJ-CREATE was a prospective, randomized, trial that compared the effects of candesartan-based therapy with those of non-ARB-based standard therapy on MACE in 2049 hypertensive patients with CAD. The target BP was less than 130/85 mmHg. The primary endpoint was the time to the first occurrence of MACE. Incidence of MACE and office BP was determined during the scheduled 6, 12, 24, 36, 48, and 60 month visits. Achieved BP was defined as the mean value of sys-BP in patients who did not meet with MACE and the mean value of sys-BP prior to MACE in those who met with MACE during follow-up.
Results: In the present study, 1734 patients had multiple follow-up visits ( ≥ 3 times) until their final follow-up were evaluated. During a median follow-up of 4.2 years, the primary outcome occurred in 317 patients (18.3%). Visit-to-visit variability of sys-BP was defined as the standard deviation (SD). The participants were divided into equal quartiles based on the mean sys-BP during follow-up and visit-to-visit variability of sys-BP, respectively. The correlation between the visit-to-visit variability of sys-BP and the mean sys-BP was weak but significant in the group as a whole (r=0.17, p≤0.001). Although visit-to-visit variability of sys-BP was not a strong predictor, a top quartile of an average of sys-BP predicted MACE (Figure).
Conclusions: Although inadequate BP control is strong predictor of subsequent MACE, visit-to-visit variability of sys-BP is not in hypertensive patients with CAD.
- © 2013 by American Heart Association, Inc.