Published Online
on July 2, 2007

A more recent version of this article appeared on August 1, 2007

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Submitted on March 12, 2007
Revised on April 1, 2007

Blood Pressure Control and Improved Cardiovascular Outcomes in the International Verapamil SR-Trandolapril Study

Giuseppe Mancia^*; Franz Messerli; George Bakris; Qian Zhou; Annette Champion; and Carl J. Pepine

From the Clinica Medica (G.M.), Dipartimento di Medicina Clinica, Prevenzione, Università Milano Bicocca, Milan, Italy; Division of Cardiology (F.M.), St Luke’s-Roosevelt Hospital, New York; Pritzker School of Medicine (G.B.), University of Chicago, Ill; Abbott Laboratories (Q.Z., A.C.), Abbott Park, Ill; and the Division of Cardiovascular Medicine (C.J.P.), Department of Medicine, University of Florida, Gainesville.

^* To whom correspondence should be addressed. E-mail: giuseppe.mancia{at}unimib.it.

Abstract--Uncontrolled blood pressure (BP) increases cardiovascular risk, independent of type of treatment. In this posthoc International Verapamil SR-Trandolapril Study analysis, we determined whether adverse outcomes are related to consistency of BP control, defined as the proportion of visits in which BP was in control. A total of 22 576 patients with hypertension and coronary artery disease were divided into 4 groups according to the proportion of visits in which BP was in control (<140/90 mm Hg): <25%, 25% to <50%, 50% to <75%, and 75%. Risk of primary outcome (first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke), myocardial infarction, and stroke decreased progressively from the group with <25% to the group with 75% of visits with BP control. Adjusted risks of primary outcome (heart rate: 0.60; 95% CI: 0.53 to 0.67), myocardial infarction (heart rate: 0.58; 95% CI: 0.48 to 0.70), and stroke (heart rate: 0.50; 95% CI: 0.37 to 0.67) were less in the group with 75% of visits with BP control compared with the group with <25% of visits with BP control. Baseline BP was not predictive of outcomes. Proportion of visits with BP control was associated with mean follow-up systolic BP (r²=0.64), both being independently related to primary outcome. As proportion of visits with BP control increases, there is an associated steep reduction in cardiovascular risk, independent of baseline characteristics and mean on-treatment BP. Consistency of BP control during treatment provides additional information on the protective effect of antihypertensive treatment. Physicians need to be concerned at each visit if BP is not controlled.

Key words: hypertension • blood pressure control • antihypertensive treatment • antihypertensive drugs • blood pressure measurement/monitoring • clinical trials

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