Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida.
Elias Emergency University Hospital, Bucharest, Romania.
J Womens Health (Larchmt). 2020 Feb;29(2):158-166. doi: 10.1089/jwh.2018.7235. Epub 2019 Aug 12.
Hypertension is a major modifiable risk factor for coronary artery disease (CAD), the main cause of death in women. While association between the two is frequent, limited data exist regarding the feasibility of blood pressure (BP) management and outcomes in women across the spectrum of CAD. Accordingly, we analyzed patient characteristics, BP control rates, and outcomes among hypertensive women with CAD, enrolled in The INternational VErapamil SR-trandolapril STudy (INVEST). The 11,770 hypertensive women with CAD in INVEST were studied based on presence ( = 3,879) or absence ( = 7,891) of history of myocardial infarction (MI) or coronary revascularization, to evaluate outcomes across risk groups based on severity of CAD. Women with prior MI or revascularization were older (4 years, < 0.0001), were predominantly white (62% vs. 29%), and had more associated comorbidities than women without these events. At 24 months, JNC VI (sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) BP control rates were lower in women with prior MI or revascularization (57% vs. 64%, < 0.0001), despite more intensive antihypertensive therapy. The primary outcome (first occurrence of all-cause death, nonfatal MI, or nonfatal stroke) was also more frequent in women with prior MI or revascularization (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.34-1.74), who were 42% more likely to die (adjusted HR 1.42; 95% CI 1.22-1.64), twice as likely to have a nonfatal MI (adjusted HR 2.4, 95% CI 1.64-3.51), and 56% more likely to have a nonfatal stroke (adjusted HR 1.56, 95% CI 1.1-2.21). In a prospective, multinational cohort of hypertensive women with CAD, those with prior MI or revascularization comprised a group at higher risk for death, nonfatal MI, and nonfatal stroke, and were less likely to have their BP controlled, despite more aggressive therapy. The feasibility and benefit of reducing BP to <130/80 mmHg in women, particularly with more severe CAD, warrant further investigation.
高血压是冠心病（CAD）的主要可改变的危险因素，也是女性死亡的主要原因。虽然两者之间存在关联，但关于在 CAD 谱范围内的女性中血压（BP）管理和结果的可行性的数据有限。因此，我们分析了患有 CAD 的高血压女性患者的特征、BP 控制率和结局，这些患者来自于国际维拉帕米 SR-群多普利研究（INVEST）。
根据是否有心肌梗死（MI）或冠状动脉血运重建史，对 INVEST 中 11770 名患有 CAD 的高血压女性患者进行了研究（有病史=3879 名，无病史=7891 名），以根据 CAD 的严重程度评估不同风险组的结局。有 MI 或血运重建史的女性年龄更大（4 岁，<0.0001），以白人为主（62%比 29%），并且与无这些事件的女性相比，有更多的合并症。在 24 个月时，根据第六次美国联合委员会（JNC）的血压控制标准（第六次报告的联合国家委员会关于预防、检测、评估和治疗高血压的报告），有 MI 或血运重建史的女性的 BP 控制率较低（57%比 64%，<0.0001），尽管进行了更强化的降压治疗。主要结局（全因死亡、非致死性 MI 或非致死性卒中的首次发生）在有 MI 或血运重建史的女性中也更为常见（校正后的危险比[HR]为 1.53，95%置信区间[CI]为 1.34-1.74），她们的死亡风险增加了 42%（校正后的 HR 为 1.42；95%CI 为 1.22-1.64），非致死性 MI 的风险增加了两倍（校正后的 HR 为 2.4，95%CI 为 1.64-3.51），非致死性卒中等风险增加了 56%（校正后的 HR 为 1.56，95%CI 为 1.1-2.21）。
在一项针对患有 CAD 的高血压女性的前瞻性、多国队列研究中，那些有 MI 或血运重建史的患者死亡、非致死性 MI 和非致死性卒中等风险更高，尽管进行了更积极的治疗，但 BP 控制率较低。在女性中，将 BP 降低到<130/80mmHg 的可行性和益处，特别是在 CAD 更严重的情况下，值得进一步研究。
