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Submitted on February 14, 2008
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. * To whom correspondence should be addressed. E-mail: scott.denardo{at}medicine.ufl.edu.
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.
Revised on March 10, 2008
Characteristics and Outcomes of Revascularized Patients With Hypertension. An International Verapamil SR-Trandolapril Substudy
Scott J. Denardo*;
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