Worse blood pressure control in patients with cerebrovascular or peripheral arterial disease compared with coronary artery disease

Abstract

Abstract. Mechtouff L, Touzé E, Steg PG, Ohman EM, Goto S, Hirsch AT, Röther J, Aichner FT, Weimar C, Bhatt DL, Alberts MJ, Mas J-L, on behalf of the REACH Registry Investigators (Paris-Descartes University; Université Paris 7; Paris, France, Duke University, Durham NC, USA, Tokai University, Isehara, Japan, University of Minnesota, Minneapolis, MN, USA, Academic Teaching Hospital Hannover Medical School, Minden, Germany, Academic Teaching Hospital Wagner-Jauregg, Linz, Austria, University of Duisburg-Essen, Essen, Germany, VA Boston Healthcare System, and Brigham and Women's Hospital, Boston, MA; and Northwestern University Medical School, Chicago, IL; USA). Worse blood pressure control in patients with cerebrovascular or peripheral arterial disease compared with coronary artery disease. J Intern Med 2010; 267: 621-633.Objectives. Poor blood pressure (BP) control is common amongst patients with symptomatic atherothrombotic disease. It is unclear whether BP control and management differ across atherothrombotic disease subtypes.Methods. We analysed the baseline data of 44 984 patients with documented coronary artery disease (CAD) only (n = 30 414), cerebrovascular disease (CVD) only (n = 11 359) and peripheral arterial disease (PAD) only (n = 3211) from the international REduction of Atherothrombosis for Continued Health Registry and investigated the impact of atherothrombotic disease subtype on BP control and use of antihypertensive drugs.Results. The proportion of patients with BP controlled (<140 ⁄ 90 mmHg) was higher in CAD (58.1%) than in CVD (44.8%) or PAD (38.9%) patients (P < 0.001).Amongst patients with treated hypertension, CAD patients were more likely to have BP controlled than were CVD patients [odds ratio (OR) = 1.67; 95% confidence interval (CI) = 1.59-1.75] or PAD (OR = 2.30; 95% CI = 2.10-2.52). These differences were smaller in women than in men and decreased with age. Amongst treated patients, CAD patients were more likely to receive ‡3-drug combination therapies than were CVD (OR = 1.73; 95% CI = 1.64-1.83) or PAD (OR = 1.64; 95% CI = 1.49-1.80) patients. Adjustment for age, gender, waist obesity, diabetes, education level and world region did not alter the results.Conclusions. Coronary artery disease patients are more likely than CVD or PAD patients to have BP controlled and to receive antihypertensive drugs, particularly combination therapies. Promotion of more effective BP control through combination antihypertensive therapies could improve secondary prevention and therefore prevent complications in CVD and PAD patients.

Secondary prevention in patients with vascular disease. A population based study on the underuse of recommended medications

“…A similar trend was found in a study based on two national registries involving primary care physicians, which demonstrated that optimal care was more frequently achieved in patients with CAD than in those with cerebral ischaemia 9 21. The reasons for such discrepancies remain hypothetical.…”

Disparities between Prescribing of Secondary Prevention Therapies for Stroke and Coronary Artery Disease in General Practice

“…Not surprisingly, the use of expensive lipid-lowering agents, most likely statins, was much higher in our study compared with the WHO-PREMISE, with over 80% of patients with coronary artery disease and 50% of those with stroke/TIA receiving such therapy. As shown elsewhere, our study shows that patients with stroke/TIA are not only less likely to be prescribed secondary prevention therapies but their BP and lipid levels are less well controlled (20,–23). The observed higher prescribing in those with TIA compared with stroke may reflect the recognition by GPs that such therapy in the former group is beneficial in reducing the risk of future stroke or possibly the perception that such patients have more to gain in terms of disability-free survival (24).…”

Main Findings on Therapeutic Management of Lower Extremity Artery Disease

“…ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial disagreed with the results of this study conducted in diabetic patients at high cardiovascular risk and showed no difference in terms of cardiovascular outcomes between intensive antihypertensive therapy (target SBP <120 mm Hg) compared to the standard (target SBP <140 mmHg) [32]. Unfortunately, in a recent study conducted in 2010, the proportion of patients whose blood pressure was kept under control was lower among those with PAD than among those with CAD (coronary artery disease) or CVD (cerebrovascular disease) [33]. It would therefore be useful to promote a more effective blood pressure control in these patients to improve their outcomes and prevent complications primarily related to PAD.…”