JUJO Kentaro    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Assistant Professor
Article types	Original article
Language	English
Peer review	Peer reviewed
Title	Impact of age on clinical outcomes of antihypertensive therapy in patients with hypertension and coronary artery disease: A sub-analysis of the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease.
Journal	Formal name：Journal of clinical hypertension (Greenwich, Conn.) Abbreviation：J Clin Hypertens (Greenwich) ISSN code：15246175/17517176
Domestic / Foregin	Foregin
Publisher	John Wiley & Sons, Inc.
Volume, Issue, Page	pp.in press
Author and coauthor	KIKUCHI Noriko†, OGAWA Hirosh*i, WATANABE Erisa, ARASHI Hiroyuki, JUJO Kentaro, SEKIGUCHI Haruki, YAMAGUCHI Junichi, HAGIWARA Nobuhisa
Publication date	2020/05
Summary	This study aimed to determine whether different systolic blood pressure (SBP) measurements achieved with antihypertensive therapy impact clinical outcomes by age in patients with hypertension and coronary artery disease (CAD). This post hoc analysis from the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Heart Disease (HIJ-CREATE) trial included 2048 patients with hypertension and angiographically documented CAD. Participants were divided into three groups based on age at enrollment: middle-aged (<60 years, n = 570), pre-elderly (≥60-<70 years, n = 730), and elderly (≥70 years, n = 748). Among the 2,048 patients, 1695 (82.7%) underwent percutaneous coronary intervention. The primary end point was the time to first occurrence of a major adverse cardiac event (MACE). During a median follow-up of 4.2 years, the MACE rate was 19.8%, 28.1%, and 31.1% in the middle-aged, pre-elderly, and elderly groups, respectively. Achieved BP was defined as the mean BP during scheduled visits. Patients with higher achieved SBP had a higher occurrence of MACE in all age groups. An unadjusted quadratic proportional hazard model was used to evaluate the relationship between achieved BP during follow-up and risk for MACE. In each age group, participants were divided into quartiles based on the achieved BP during follow-up. The relationship between achieved SBP and the incidence of MACE did not follow a J-shaped curve in any age group. In conclusion, in the contemporary era of aggressive coronary revascularization, a lower SBP target may be appropriate even in elderly patients with hypertension and CAD.
DOI	10.1111/jch.13891
PMID	32475050