Long-Term Mortality in Hypertensive Patients With Coronary Artery Disease

Elgendy, Islam Y.; Bavry, Anthony A.; Gong, Yan; Handberg, Eileen M.; Cooper‐DeHoff, Rhonda M.; Pepine, Carl J.

doi:10.1161/hypertensionaha.116.07854

Cited by 26 publications

(16 citation statements)

References 21 publications

(30 reference statements)

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“…The only subgroup who benefited from BP lowering was the subgroup of participants with initial systolic BP > 143.5 mmHg [44]. A recent study that used the extended follow-up data from the US cohort of the International Verapamil [SR]/Trandolapril Study (INVEST) showed that in hypertensive patients with coronary artery disease, achieving a systolic BP of 130–140 mmHg seems to be associated with lower all-cause mortality after approximately 11.6 years of follow-up [45]. Similarly, the Secondary Prevention of Small Subcortical Strokes (SPS3) trial) evaluated BP goals in patients with a previous lacunar stroke testing a systolic goal of 130–149 mmHg versus <130 mmHg [46].…”

Section: Introductionmentioning

confidence: 99%

Blood pressure control in type 2 diabetic patients

Grossman

2017

Cardiovasc Diabetol

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Diabetes mellitus (DM) and essential hypertension are common conditions that are frequently present together. Both are considered risk factors for cardiovascular disease and microvascular complications and therefore treatment of both conditions is essential. Many papers were published on blood pressure (BP) targets in diabetic patients, including several works published in the last 2 years. As a result, guidelines differ in their recommendations on BP targets in diabetic patients. The method by which to control hypertension, whether pharmacological or non-pharmacological, is also a matter of debate and has been extensively studied in the literature. In recent years, new medications were introduced for the treatment of DM, some of which also affect BP and the clinician treating hypertensive and diabetic patients should be familiar with these medications and their effect on BP. In this manuscript, we discuss the evidence supporting different BP targets in diabetics and review the various guidelines on this topic. In addition, we discuss the various options available for the treatment of hypertension in diabetics and the recommendations for a specific treatment over the other. Finally we briefly discuss the new diabetic drug classes and their influence on BP.

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Section: Introductionmentioning

confidence: 99%

Blood pressure control in type 2 diabetic patients

Grossman

2017

Cardiovasc Diabetol

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“…Compared with the reference group of <140 mmHg, SBP between 140 and < 150 mmHg was associated with an increased risk of cardiovascular mortality (HR: 1.34, 95% CI: 1.01-1.77, p=0.04), total stroke (HR: 1.89, 95% CI: 1.26-2.82, p=0.002), and nonfatal stroke (HR: 1.70, 95% CI: 1.06-2.72, p=0.03). In the long term (median 11.6 years) follow up of the US cohort (17,000 patients) of the INVEST, achieving a SBP 130 to 140 mmHg was associated with lower all-cause mortality [10]. It is important to note that data regarding BP control beyond the active follow up of the trial were not available in this later analysis from the US cohort.…”

Section: Clinical Evidence Regarding Target Levels Of Treatmentmentioning

confidence: 99%

“…Several studies have shown significant reductions in cardiovascular mortality with improved blood pressure control [6-9]. This relationship between adverse clinical outcomes and hypertension is amplified in patients with underlying CAD [10]. The existence of a J-curve phenomenon was proposed by findings suggestive of worsened ischemia-related outcomes with the extremes of blood pressure (BP) [11-14].…”

Section: Introductionmentioning

confidence: 99%

Optimal medical treatment of hypertension in patients with coronary artery disease

Mahtta

Elgendy

Pepine

2018

Expert Review of Cardiovascular Therapy

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Introduction: Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, and hypertension is its most prevalent modifiable risk factor. Patients with CAD and concomitant hypertension are a special population with distinct physiologic and structural alterations. Optimal blood pressure (BP) control in this population has been linked with reduction in adverse outcomes, however, excessive lowering of BP could jeopardize myocardial and cerebral perfusion. Areas covered: Authors highlight the prevalence of the CAD and hypertension dyad, as well as the implications of various structural and physiological changes in this population. Subsequently, available data on optimal BP targets in such patients, and lastly provide more insight into the J-curve phenomenon as well as antihypertensive agent use is discussed. Expert commentary: Current guideline recommendations are based on data from trials such as SPRINT which did not specifically focus on the CAD population. Based on data from observational studies and post hoc analyses, the best therapeutic systolic (SBP) and diastolic (DBP) targets may be ~130 mmHg and ~80 mmHg, respectively. Caution should be taken to not lower SBP below 120 mmHg and DBP below 60 mmHg.

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“…Multiple studies evaluating the role of regular exercise have documented reduction in angina and improvement in endothelial dysfunction, myocardial perfusion, and physical work capacity with regression of coronary artery plaque [12, 13]. Weight management with goal BMI 18.5–24.9 kg/m2, smoking cessation, meticulous management of blood pressure (systolic <120 mmHg) [14], and reduction of LDL-cholesterol and euglycemia have been shown to improve overall cardiovascular outcomes and mortality [15]. In a prospective trial of 300 patients randomized to either usual care or multifactor risk reduction (low-fat and -cholesterol diet, exercise, weight loss, smoking cessation, and medications to favorably alter lipoprotein profiles), the multifactor risk reduction group had 47% reduction in rate of narrowing of diseased coronary artery segments and fewer hospitalizations for cardiac-related events [16].…”

Section: Management Of Anginamentioning

confidence: 99%

Advancements in pharmacotherapy for angina

Jain

Elgendy

Al‐Ani

et al. 2017

Expert Opinion on Pharmacotherapy

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Introduction Angina pectoris is the most prevalent symptomatic manifestation of ischemic heart disease, frequently leads to a poor quality of life, and is a major cause of medical resource consumption. Since the early descriptions of nitrite and nitrate in the 19th century, there has been considerable advancement in the pharmacologic management of angina. Areas covered Management of chronic angina is often challenging for clinicians. Despite introduction of several pharmacological agents in last few decades, a significant proportion of patients continue to experience symptoms (i.e., refractory angina) with subsequent disability. For the purpose of this review, we searched PubMed and Cochrane databases from inception to August 2016 for the most clinically relevant publications that guide current practice in angina therapy and its development. In this article, we briefly review the pathophysiology of angina and mechanism-based classification of current therapy. This is followed by evidence-based insight into the traditional and novel pharmacotherapeutic agents, highlighting their clinical usefulness. Expert opinion Considering the wide array of available therapies with different mechanism efficacy and limiting factors, a personalized approach is essential, particularly for patients with refractory angina. Ongoing research with novel pharmacologic modalities is likely to provide new options for management of angina.

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Long-Term Mortality in Hypertensive Patients With Coronary Artery Disease

Cited by 26 publications

References 21 publications

Blood pressure control in type 2 diabetic patients

Blood pressure control in type 2 diabetic patients

Optimal medical treatment of hypertension in patients with coronary artery disease

Advancements in pharmacotherapy for angina

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