Mortality implications of angina and blood pressure in hypertensive patients with coronary artery disease: New data from extended follow-up of the International Verapamil/Trandolapril Study (INVEST).
Mortality implications of angina and blood pressure in hypertensive patients with coronary artery disease: New data from extended follow-up of the International Verapamil/Trandolapril Study (INVEST).
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DOI：
10.1002/clc.22145
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发表时间：
2013-08
影响因子：
2.7
通讯作者：
Pepine, Carl J.
中科院分区：
文献类型：
--
作者：
Winchester, David E.;Cooper-DeHoff, Rhonda M.;Gong, Yan;Handberg, Eileen M.;Pepine, Carl J.
心绞痛和高血压在冠状动脉疾病 (CAD) 患者中很常见，但其对死亡率的影响尚不清楚。我们对国际维拉帕米/群多普利研究 (INVEST) 进行了这项预先设定的分析，以评估老年高血压 CAD 患者心绞痛、血压 (BP) 和死亡率之间的关系。心绞痛和血压升高与较高的死亡率相关。使用美国 INVEST 患者国家死亡指数 (n=16,951) 进行了长期随访。根据入组时和随访期间的心绞痛病史，将患者分为以下几组：持续发作（n=7184）、新发（n=899）、缓解（n=4070）或从未发作（n=4798）。在基线、药物滴定期间和后续治疗期间评估血压。治疗中收缩压分为严格控制（<130 mmHg）、控制（130-139 mmHg）或未控制（≥140 mmHg）。创建了 Cox 比例风险模型，根据年龄、心力衰竭、糖尿病、肾功能损害、心肌梗死、中风和吸烟进行调整。以从未心绞痛组为参照，比较心绞痛组和BP对照组。仅在持续性心绞痛组中观察到与死亡率显着相关，并具有明显的保护作用（HR 0.82，95% CI 0.75 至 0.89，P <0.0001）。血压不受控制与死亡风险增加相关（HR 1.29，95% CI 1.20 至 1.40，P <0.0001），其他几个已知的心血管危险因素也是如此。在高血压 CAD 患者中，持续性心绞痛与较低的死亡率相关。与其他心血管危险因素（例如与死亡率增加相关的血压）相比，观察到的影响较小。
Angina and hypertension are common in patients with coronary artery disease (CAD), however the effect on mortality is unclear. We conducted this prespecified analysis of the INternational VErapamil/Trandolapril STudy (INVEST) to assess relationships between angina, blood pressure (BP), and mortality among elderly, hypertensive CAD patients. Angina and elevated BP will be associated with higher mortality. Extended follow-up was performed using the National Death Index for INVEST patients in the United States (n=16,951). Based on angina history at enrollment and during follow-up visits, patients were divided into groups: persistent (n=7184), new onset (n=899), resolved (n=4070), or never (n=4798). BP was evaluated at baseline, during drug titration and during follow-up on-treatment. On-treatment systolic BP was classified as tightly controlled (<130 mmHg), controlled (130–139 mmHg), or uncontrolled (≥140 mmHg). A Cox proportional hazards model was created adjusting for age, heart failure, diabetes, renal impairment, myocardial infarction, stroke, and smoking. The angina groups and BP control groups were compared using the never angina group as the reference. Only in the persistent angina group was a significant association with mortality observed, with an apparent protective effect (HR 0.82, 95% CI 0.75 to 0.89, P <0.0001). Uncontrolled BP was associated with increased mortality risk (HR 1.29, 95% CI 1.20 to 1.40, P <0.0001), as were several other known cardiovascular risk factors. In hypertensive CAD patients, persistent angina was associated with lower mortality. The observed effect was small compared with other cardiovascular risk factors, such as BP, which were associated with increased mortality.
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影响因子：
120.7
作者：
Cooper-DeHoff, Rhonda M.;Gong, Yan;Handberg, Eileen M.;Bavry, Anthony A.;Denardo, Scott J.;Bakris, George L.;Pepine, Carl J.
通讯作者：
Pepine, Carl J.
影响因子：
5.7
作者：
Brorsson, B;Bernstein, SJ;Werkö, L
通讯作者：
Werkö, L
影响因子：
120.7
作者：
Pepine, CJ;Handberg, EM;Parmley, WW
通讯作者：
Parmley, WW
影响因子：
2.8
作者：
KANNEL, WB;FEINLEIB, M
通讯作者：
FEINLEIB, M
影响因子：
168.9
作者：
Lewington, S;Clarke, R;Collins, R
通讯作者：
Collins, R