Abstract 15316: Impact of Left Ventricular Systolic Function on Blood Pressure Lowering Effects in Hypertensive Patients With Coronary Artery Disease: the Hij-create Sub-study
Purpose: To evaluate the relationship between left ventricular systolic function and blood pressure (BP) lowering effects 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 major adverse cardiac events (MACE) in 2,049 hypertensive patients with angiographically documented CAD. Left ventricular ejection fraction (LVEF) was determined by contrast ventriculography, radionuclide ventriculography, or echocardiography on enrollment in this trial. Titration of antihypertensive agents was performed to reach the target BP of <130/85 mmHg. The primary endpoint was the time to first MACE. Incidence of endpoint events in addition to 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: Participants were divided into 3 groups based on LVEF; < 45% (n=386), 45% < <55% (n=524), and ≤ 55% (n=999). Percutaneous coronary interventions had been performed in 86.0% for the lowest, 80.9% for the second, and in 80.2% for the normal LVEF group patients. During a median follow-up of 4.2 years (follow-up rate of 99.6%), event rates were 30.6% for the lowest, 27.6% for the second, and 24.0% for the normal
LVEF group patients. The relationships between achieved systolic BP and the incidence of MACE did not follow J-shaped except for normal LVEF group patients (Figure).
Conclusions: Although the results of the present study did not confirm “the lower, the better” theory in BP lowering therapy for hypertensive patients with CAD, our results may highlight the significance of intensive BP lowering in hypertensive patients with CAD and reduced LVEF.
Author Disclosures: H. Ogawa: None. E. Kawada-Watanabe: None. H. Otsuki: None. S. Haruki: None. N. Kikuchi: None. J. Yamaguchi: None. N. Hagiwara: None.
- © 2014 by American Heart Association, Inc.