Department School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine Position Associate Professor
|Article types||Original article|
|Peer review||Peer reviewed|
|Title||Optimal Blood Pressure in Patients With Coronary Artery Disease and Chronic Kidney Disease: HIJ-CREATE Substudy.|
|Journal||Formal name：The American journal of the medical sciences|
Abbreviation：Am J Med Sci
|Domestic / Foregin||Foregin|
|Publisher||Lippincott Williams & Wilkins|
|Volume, Issue, Page||358(3),219-226頁|
|Author and coauthor||TANAKA Kazuki†, JUJO Kentaro*, YAMAGUCHI Junichi, OGAWA Hiroshi, HAGIWARA Nobuhisa|
Lowering blood pressure (BP) is important in improving the prognosis of hypertensive patients with coronary artery disease (CAD). Patients suffering CAD with chronic kidney disease (CKD) have poorer prognosis than those without CKD. However, there is limited evidence regarding the benefit of BP-lowering therapy on cardiovascular outcomes in patients with CAD and CKD. In this study, we aimed to evaluate the relation between major adverse cardiac events (MACE) and achieved BP in hypertensive patients with CAD and CKD as a high-risk population.
This study was a post-hoc analysis from the HIJ-CREATE trial, a multicenter, prospective, randomized controlled study comparing the effects of antihypertensive therapy with and without candesartan on MACE in 2049 hypertensive patients with angiographically documented CAD. Of these, 1,002 patients had CKD with a diagnosis of estimated glomerular filtration rate (eGFR) <60 mL/minute/1.73m2. The primary endpoint was the time to first MACE. The participants were divided into quartiles based on the mean systolic or diastolic BP during the follow-up period.
Compared between the quartiles, intensive lowering of diastolic BP increased the incidence of MACE in CKD patients; however, intensive lowering of systolic BP did not worsen the incidence of MACE. Therefore, the relationship between achieved diastolic BP and the incidence of MACE showed a "reverse J-shape" curve in the study population.
Intensive lowering of systolic BP in hypertensive patients with CAD and CKD does not correlate with an increased risk of MACE. In contrast, excessive lowering of diastolic BP with antihypertensive treatment results in increased MACE.