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Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy.

Publication ,  Journal Article
Denardo, SJ; Gong, Y; Nichols, WW; Messerli, FH; Bavry, AA; Cooper-Dehoff, RM; Handberg, EM; Champion, A; Pepine, CJ
Published in: Am J Med
August 2010

BACKGROUND: Our understanding of the growing population of very old patients (aged >or=80 years) with coronary artery disease and hypertension is limited, particularly the relationship between blood pressure and adverse outcomes. METHODS: This was a secondary analysis of the INternational VErapamil SR-Trandolapril STudy (INVEST), which involved 22,576 clinically stable hypertensive coronary artery disease patients aged >or=50 years. The patients were grouped by age in 10-year increments (aged >or=80, n=2180; 70-<80, n=6126; 60-<70, n=7602; <60, n=6668). Patients were randomized to either verapamil SR- or atenolol-based treatment strategies, and primary outcome was first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS: At baseline, increasing age was associated with higher systolic blood pressure, lower diastolic blood pressure, and wider pulse pressure (P <.001). Treatment decreased systolic, diastolic, and pulse pressure for each age group. However, the very old retained the widest pulse pressure and the highest proportion (23.6%) with primary outcome. The adjusted hazard ratio for primary outcomes showed a J-shaped relationship among each age group with on-treatment systolic and diastolic pressures. The systolic pressure at the hazard ratio nadir increased with increasing age, highest for the very old (140 mm Hg). However, diastolic pressure at the hazard ratio nadir was only somewhat lower for the very old (70 mm Hg). Results were independent of treatment strategy. CONCLUSION: Optimal management of hypertension in very old coronary artery disease patients may involve targeting specific systolic and diastolic blood pressures that are higher and somewhat lower, respectively, compared with other age groups.

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Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

August 2010

Volume

123

Issue

8

Start / End Page

719 / 726

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Systole
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Hypertension
  • Humans
  • General & Internal Medicine
  • Female
  • Diastole
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Denardo, S. J., Gong, Y., Nichols, W. W., Messerli, F. H., Bavry, A. A., Cooper-Dehoff, R. M., … Pepine, C. J. (2010). Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy. Am J Med, 123(8), 719–726. https://doi.org/10.1016/j.amjmed.2010.02.014
Denardo, Scott J., Yan Gong, Wilmer W. Nichols, Franz H. Messerli, Anthony A. Bavry, Rhonda M. Cooper-Dehoff, Eileen M. Handberg, Annette Champion, and Carl J. Pepine. “Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy.Am J Med 123, no. 8 (August 2010): 719–26. https://doi.org/10.1016/j.amjmed.2010.02.014.
Denardo SJ, Gong Y, Nichols WW, Messerli FH, Bavry AA, Cooper-Dehoff RM, et al. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy. Am J Med. 2010 Aug;123(8):719–26.
Denardo, Scott J., et al. “Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy.Am J Med, vol. 123, no. 8, Aug. 2010, pp. 719–26. Pubmed, doi:10.1016/j.amjmed.2010.02.014.
Denardo SJ, Gong Y, Nichols WW, Messerli FH, Bavry AA, Cooper-Dehoff RM, Handberg EM, Champion A, Pepine CJ. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy. Am J Med. 2010 Aug;123(8):719–726.
Journal cover image

Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

August 2010

Volume

123

Issue

8

Start / End Page

719 / 726

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Systole
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Hypertension
  • Humans
  • General & Internal Medicine
  • Female
  • Diastole