Blood Pressure and Outcomes in Very Old Hypertensive Coronary Artery Disease Patients: An INVEST Substudy
Abstract
Background
Our understanding of the growing population of very old patients (aged ≥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 ≥50 years. The patients were grouped by age in 10-year increments (aged ≥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.
Requests for reprints should be addressed to Scott J. Denardo, MD, Division of Cardiovascular Medicine, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100277, Gainesville, FL 32610
Funding: Financial support for this research: None. Financial support for original INVEST: University of Florida (Gainesville, Fla); Abbott Laboratories (Abbott Park, Ill).
Conflict of Interest: Potential conflicts of interest: Dr. Denardo: None; Dr. Gong: None; Dr. Nichols: None; Dr. Messerli: Abbott Laboratories (ad hoc consultant; speaker); Dr. Cooper-DeHoff: Abbott Laboratories (grant); Dr. Handberg: Abbott Laboratories (grant); Ms. Champion: Abbott Laboratories (employee; stock/stock options); Dr. Pepine: Abbott Laboratories (grant; ad hoc consultant).
Authorship: All authors had access to the data and a role in writing the manuscript.
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