Characteristics and outcomes of revascularized patients with hypertension: an international verapamil SR-trandolapril substudy

Abstract

Our understanding of the growing population of revascularized patients with hypertension is limited. We retrospectively analyzed the International Verapamil SR-Trandolapril Study, which randomized coronary artery disease patients with hypertension to either verapamil SR- or atenolol-based treatment strategies, focusing on characteristics and outcomes of 6166 previously revascularized patients compared with 16 410 nonrevascularized patients. Revascularized patients had a history of coronary artery bypass grafting (45.2%), percutaneous coronary intervention (42.1%), or both (12.8%). Compared with nonrevascularized patients, revascularized patients at baseline demonstrated a higher prevalence of coronary artery disease risk factors and risk conditions (P<0.001). This higher prevalence was the principal cause of a higher incidence of primary outcome (death, nonfatal myocardial infarction, or nonfatal stroke) among revascularized patients (14.2% versus 8.5% for nonrevascularized patients; P<0.001). However, both patient groups demonstrated a relatively low incidence of subsequent revascularization (5.1% versus 1.5% respectively; P<0.0001). Associations between adjusted hazard ratio for primary outcome and follow-up blood pressure appeared "J shaped" for both patient groups. Because, as a group, revascularized patients with hypertension had worse outcomes compared with nonrevascularized patients, management of blood pressure to a specific target in future studies could result in improved outcomes.

Figures

Figure 1

BP control for revascularized and nonrevascularized patients. The mean follow-up period was 32.9±10.3 months.

Figure 2

Risk for clinical outcomes for revascularized and nonrevascularized patients.

Figure 3

Survival without primary outcome as a function of time and revascularization status.

Figure 4

Incidence of primary outcome (bar graphs) and HR (line graphs; adjusted for baseline conditions, without propensity score analysis) as a function of SBP and DBP in patients with and without previous revascularization. Reference SBP and DBP for HR: 140 and 90 mm Hg, respectively.

Figure 5

Comparison of HR (adjusted for baseline conditions) without and with propensity score analysis as a function of SBP and DBP in patients with and without previous revascularization. Reference SBP and DBP for HR: 140 and 90 mm Hg, respectively.