Denardo Scott J, Messerli Franz H, Gaxiola Efrain, Aranda Juan M, Cooper-Dehoff Rhonda M, Handberg Eileen M, Gong Yan, Champion Annette, Zhou Qian, Pepine Carl J
Division of Cardiovascular Medicine, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100277, Gainesville, FL 32610, USA.
Hypertension. 2009 Apr;53(4):624-30. doi: 10.1161/HYPERTENSIONAHA.108.111542. Epub 2009 Feb 23.
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.
我们对高血压血管重建患者群体不断增加的了解有限。我们回顾性分析了国际维拉帕米缓释片-群多普利研究，该研究将患有高血压的冠状动脉疾病患者随机分为以维拉帕米缓释片或阿替洛尔为基础的治疗策略组，重点关注6166例既往接受血管重建的患者与16410例未接受血管重建的患者的特征和结局。接受血管重建的患者有冠状动脉旁路移植术史（45.2%）、经皮冠状动脉介入治疗史（42.1%）或两者兼有的病史（12.8%）。与未接受血管重建的患者相比，接受血管重建的患者在基线时冠状动脉疾病危险因素和风险状况的患病率更高（P<0.001）。这种较高的患病率是接受血管重建的患者主要结局（死亡、非致命性心肌梗死或非致命性中风）发生率较高的主要原因（接受血管重建的患者为14.2%，未接受血管重建的患者为8.5%；P<0.001）。然而，两组患者随后进行血管重建的发生率都相对较低（分别为5.1%和1.5%；P<0.0001）。两组患者主要结局的调整后风险比与随访血压之间的关联均呈“J形”。由于高血压血管重建患者作为一个群体与未接受血管重建的患者相比结局更差，因此在未来研究中将血压控制到特定目标可能会改善结局。
