心绞痛和血压对合并冠心病的高血压患者死亡率的影响：国际维拉帕米/曲多普利研究（INVEST）扩展随访的新数据。

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).

机构信息

Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida.

出版信息

Clin Cardiol. 2013 Aug;36(8):442-7. doi: 10.1002/clc.22145. Epub 2013 May 29.

DOI:10.1002/clc.22145

PMID:23720247

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3775918/

Abstract

BACKGROUND

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.

HYPOTHESIS

Angina and elevated BP will be associated with higher mortality.

METHODS

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 angina (n = 7184), new-onset angina (n = 899), resolved angina (n = 4070), and never angina (n = 4798). Blood pressure was evaluated at baseline, during drug titration, and during follow-up on-treatment. On-treatment systolic BP was classified as tightly controlled (<130 mm Hg), controlled (130-139 mm Hg), or uncontrolled (≥140 mm Hg). 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.

RESULTS

Only in the persistent-angina group was a significant association with mortality observed, with an apparent protective effect (hazard ratio: 0.82, 95% confidence interval: 0.75-0.89, P < 0.0001). Uncontrolled BP was associated with increased mortality risk (hazard ratio: 1.29, 95% confidence interval: 1.20-1.40, P < 0.0001), as were several other known cardiovascular risk factors.

CONCLUSIONS

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.

摘要

背景

心绞痛和高血压在冠心病（CAD）患者中很常见；然而，其对死亡率的影响尚不清楚。我们对国际维拉帕米/曲多普利研究（INVEST）进行了这项预设分析，以评估老年高血压 CAD 患者心绞痛、血压（BP）与死亡率之间的关系。

假说

心绞痛和血压升高与更高的死亡率相关。

方法

使用美国 INVEST 患者的国家死亡指数对扩展随访进行分析（n = 16951）。根据入组时和随访期间的心绞痛病史，患者分为以下组：持续性心绞痛（n = 7184）、新发心绞痛（n = 899）、缓解性心绞痛（n = 4070）和从未有过心绞痛（n = 4798）。血压在基线、药物滴定期间和治疗期间随访时进行评估。治疗期间收缩压分为严格控制（<130mmHg）、控制（130-139mmHg）或未控制（≥140mmHg）。创建 Cox 比例风险模型，调整年龄、心力衰竭、糖尿病、肾功能不全、心肌梗死、卒中和吸烟因素。使用从未有过心绞痛组作为参考，比较心绞痛组和 BP 控制组。