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Coronary artery disease and arterial hypertension: clinical, angiographic and follow-up data
1Metabolism Unit and the Coronary Division of the C.N.R. Institute of Clinical Physiology, Department of Internal Medicine of the University of Pisa, Pisa, Italy. anatali@ifc.pi.cnr.it
Insights
Hypertension increases the likelihood of three-vessel coronary artery disease and non-fatal myocardial infarction in patients with ischaemic heart disease. However, overall prognosis and cardiovascular mortality are only marginally affected by high blood pressure.
Area of Science:
- Cardiology
- Vascular Medicine
- Hypertension Research
Background:
- Arterial hypertension is a significant risk factor for cardiovascular disease.
- Its specific impact on coronary atherosclerosis and patient prognosis requires detailed evaluation.
Purpose of the Study:
- To assess the relationship between hypertension and coronary atherosclerosis.
- To determine the effect of hypertension on the prognosis of patients with ischaemic heart disease.
Main Methods:
- Retrospective analysis of clinical records and follow-up data from 1700 patients undergoing coronary angiography.
- Inclusion criteria: patients with or at high risk of ischaemic heart disease.
Main Results:
- Hypertension was associated with a higher likelihood of three-vessel coronary artery disease (OR=1.41).
- Hypertensive patients showed increased overall atherosclerotic burden and a higher risk of non-fatal myocardial infarction post-discharge (OR=1.21).
- Cardiovascular mortality was slightly higher in hypertensives, but not independently significant after adjustment.
Conclusions:
- Hypertension is a risk factor for the presence of three-vessel coronary artery disease.
- While coronary stenosis severity and extension were similar, hypertension marginally impacts overall prognosis but increases the risk of non-fatal myocardial infarction.
Objectives:
To evaluate how the presence of arterial hypertension affects coronary atherosclerosis and prognosis in patients with, or at high risk of, ischaemic heart disease.
Design:
Retrospective analysis of clinical records and follow-up data.
Settings:
Single referral centre for ischaemic heart disease.
Subjects:
All consecutive patients (n = 1700, 38% with hypertension) undergoing coronary angiography for the evaluation of ischaemic heart disease during 1983-92.
Results:
On angiography, the likelihood of having three-vessel disease was higher amongst hypertensives (odds ratio = 1.41; 95% confidence interval [CI] = 1.08-1.85) after adjustment for age, sex, and angina symptoms. The sum of all visible stenoses (an index of overall atherosclerotic involvement) was 19% higher in hypertensives (262 +/- 204 vs. 220 +/- 194 units, P < 0.005). By multivariate analysis, the presence of hypertension made a modest (+ 28 units), albeit statistically significant, independent contribution to the total atherosclerosis score. On follow-up (median = 96 months), cardiovascular mortality was slightly higher in the hypertensive patients than in the normotensive group (P < 0.05 in a Kaplan-Meier analysis), but a proportional hazard analysis adjusting for age and gender showed no significant independent contribution of hypertension. Hypertensive patients, however, remained at higher risk of non-fatal myocardial infarction following discharge (adjusted odds ratio = 1.21, 95% CI = 1.03-1.46; P < 0.05).
Conclusions:
In this referral population, hypertension is a risk factor for presence of three-vessel disease. Distribution, severity and extension of coronary stenosis are similar to those of normotensive patients, and prognosis is only marginally affected.