This Article Full Text Full Text (PDF) All Versions of this Article: 53/4/624    most recent HYPERTENSIONAHA.108.111542v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Denardo, S. J. Articles by Pepine, C. J. Search for Related Content PubMed PubMed Citation Articles by Denardo, S. J. Articles by Pepine, C. J. Related Collections Cardiovascular Pharmacology Secondary prevention Risk Factors Clinical Studies CV surgery: coronary artery disease Chronic ischemic heart disease Coronary circulation

(Hypertension. 2009;53:624.)
© 2009 American Heart Association, Inc.

Original Articles

Characteristics and Outcomes of Revascularized Patients With Hypertension

An International Verapamil SR-Trandolapril Substudy

Scott J. Denardo; Franz H. Messerli; Efrain Gaxiola; Juan M. Aranda, Jr; Rhonda M. Cooper-DeHoff; Eileen M. Handberg; Yan Gong; Annette Champion; Qian Zhou; Carl J. Pepine

From the Division of Cardiovascular Medicine, College of Medicine (S.J.D., J.M.A., R.M.C-D., E.M.H., C.J.P.), and Center for Pharmacogenomics, College of Pharmacy (Y.G.), University of Florida, Gainesville; Division of Cardiology, St Luke’s-Roosevelt Hospital Center and Columbia University, College of Medicine and Physicians (F.H.M.), New York, NY; Division of Clinical Cardiology, Jardínes Hospital de Especialidades (E.G.), Guadalajara, Mexico; and Abbott Laboratory (A.C., Q.Z.), Abbott Park, Ill.

Correspondence to Scott J. Denardo, Division of Cardiovascular Medicine, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100277, Gainesville, FL 32610. E-mail scott.denardo{at}medicine.ufl.edu

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.

Key Words: hypertension • blood pressure • coronary artery disease • revascularization • coronary artery bypass grafting • percutaneous coronary intervention • epidemiology