Abstract
Background: Despite a high prevalence of hypertension in the population with CAD, there are limited data describing the clinical characteristics and treatments, as well as their interrelations in these patients. This is particularly true for black and Hispanic patients who have been underrepresented in randomized CAD trials.
Hypothesis: There exist racial and ethnic differences that define the characteristics of patients with both coronary artery disease (CAD) and hypertension.
Methods: This report describes the characteristics of Caucasian, Hispanic, and black patients enrolled in the International Verapamil SR/trandolapril Study (INVEST), a prospective trial undertaken exclusively in patients with CAD and hypertension.
Results: In all, 10,925 Caucasian, 8,045 Hispanic, and 3,029 black patients are described. An abnormal angiogram or documented myocardial infarction was observed more frequently in Caucasian patients (73%), while angina pectoris was more prevalent in Hispanic patients (87%). Diabetes and left ventricular hypertrophy were most common in black patients (33 and 29%, respectively), while hypercholesterolemia and prior revascularization (coronary artery bypass graft or angioplasty) were most common in Caucasian patients (64 and 41%, respectively). More than 60% of Hispanic and black patients were women—a unique characteristic for randomized CAD trials. Comparing race/ethnic cohorts, there were significant differences for all characteristics. More than 80% of patients in all race/ethnic groups were receiving antihypertensive therapy; however, only fewer than 25% had controlled blood pressure according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.
Conclusions: This high‐risk population of hypertensive patients with CAD has been undertreated and does not have well‐controlled B P. Race/ethnic differences were observed for clinical characteristics and medication use.
Keywords: coronary artery disease, hypertension, comorbidity, blood pressure control, Hispanic, black
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References
- 1. Bonow RO, Smaha LA, Smith SC Jr, Mensah GA, Lenfant C: World Heart Day 2002: The international burden of cardiovascular disease: Responding to the emerging global epidemic. Circulation 2002; 106: 1602–1605 [DOI] [PubMed] [Google Scholar]
- 2. Hansson L, Zanchetti I, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling S: Effects of intensive blood‐pressure lowering and low‐dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998; 351: 1755–1762 [DOI] [PubMed] [Google Scholar]
- 3. Hansson L, Hedner T, Lund‐Johansen P, Kjeldsen SE, Lindholm LH, Syvertsen JO, Lanke J, De Faire U, Dahlof B, Karlberg BE: Randomised trial of effects of calcium antagonists compared with diuretics and β‐blockers on cardiovascular morbidity and mortality in hypertension: The Nordic Diltiazem (NORDIL) study. Lancet 2000; 356: 359–365 [DOI] [PubMed] [Google Scholar]
- 4. Brown MJ, Palmer CR, Castaigne A, De Leeuw PW, Mancia G, Rosenthal T, Ruilope LM: Morbidity and mortality in patients randomised to double‐blind treatment with a long‐acting calcium‐channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet 2000; 356: 366–372 [DOI] [PubMed] [Google Scholar]
- 5. Grimm RH Jr, Margolis KL, Papademetriou VV, Cushman WC, Ford CE, Bettencourt J, Alderman MH, Basile JN, Black HR, DeQuattro VV, Eckfeldt J, Hawkins CM, Perry HM Jr, Proschan M: Baseline characteristics of participants in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension 2001; 37: 19–27 [DOI] [PubMed] [Google Scholar]
- 6. ALLHAT Officers and Coordinators, ALLHAT Collaborative Research Group : Major outcomes in high‐risk hypertensive patients randomized to angiotensin‐converting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Am Med Assoc 2002; 288: 2981–2997 [DOI] [PubMed] [Google Scholar]
- 7. Black HR, Elliott WJ, Neaton JD, Grandits G, Grambsch P, Grimm RH Jr, Hansson L, Lacoucière Y, Muller J, Sleight P, Weber MA, White WB, Williams G, Wittes J, Zanchetti A, Fakouhi TD, Anders RJ: Baseline characteristics and early blood pressure control in the CONVINCE trial. Hypertension 2001; 37: 12–18 [DOI] [PubMed] [Google Scholar]
- 8. Black HR, Elliott WJ, Grandits G, Grambsch P, Lucente T, White WB, Neaton JD, Grimm RH Jr, Hansson L, Lacourcière Y, Muller J, Sleight P, Weber MA, Williams G, Wittes J, Zanchetti A, Anders RJ: Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial. J Am Med Assoc 2003; 289: 2073–2082 [DOI] [PubMed] [Google Scholar]
- 9. Pepine CJ, Handberg‐Thurmond E, Marks RG, Conlon M, Cooper‐DeHoff R, Volders P, Zellig P: Rationale and design of the International Verapamil SR/Trandolapril Study (INVEST): An Internet‐based randomized trial in coronary artery disease patients with hypertension. J Am Coll Cardiol 1998; 32: 1228–1237 [DOI] [PubMed] [Google Scholar]
- 10. Pepine CJ, Handberg EM, Cooper‐DeHoff RM, Marks RG, Kowey P, Messerli FH, Mancia G, Cangiano JL, Garcia‐Barreto D, Keltai M, Erdine S, Bristol HA, Kolb HR, Bakris GL, Cohen JD, Parmley WW: A calcium antagonist vs. a non‐calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil‐Trandol‐april Study (INVEST): a randomized controlled trial. J Am Med Assoc 2003; 290: 2805–2816 [DOI] [PubMed] [Google Scholar]
- 11. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413–2446 [DOI] [PubMed] [Google Scholar]
- 12. Dahlof B, Devereux RB, Julius S, Kjeldsen SE, Beevers G, de Faire U, Fyhrquist F, Hedner T, Ibsen H, Kristianson K, Lederballe‐Pedersen O, Lindholm LH, Nieminen MD, Omvik P, Oparil S, Wedel H: Characteristics of 9194 patients with left ventricular hypertrophy: The LIFE study. Losartan Intervention For Endpoint Reduction in Hypertension. Hypertension 1998; 32: 989–997 [DOI] [PubMed] [Google Scholar]
- 13. Dahlof B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe‐Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H: Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): A randomised trial against atenolol. Lancet 2002; 359: 995–1003 [DOI] [PubMed] [Google Scholar]
- 14. Futterman LG, Lemberg L: Fifty percent of patients with coronary artery disease do not have any of the conventional risk factors. Am J Crit Care 1998; 7: 240–244 [PubMed] [Google Scholar]
- 15. Braunwald E. Shattuck lecture—Cardiovascular medicine at the turn of the millennium: Triumphs, concerns, and opportunities. N Engl J Med 1997; 337: 1360–1369 [DOI] [PubMed] [Google Scholar]
- 16. Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ: Prevalence of conventional risk factors in patients with coronary heart disease. J Am Med Assoc 2003; 290: 898–904 [DOI] [PubMed] [Google Scholar]
- 17. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G: Effects of an angiotensin‐converting‐enzyme inhibitor, ramipril, on cardiovascular events in high‐risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342: 145–153 [DOI] [PubMed] [Google Scholar]