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Optimal Blood Pressure in Patients With Coronary Artery Disease and Chronic Kidney Disease: HIJ-CREATE Substudy
Kazuki Tanaka1, Kentaro Jujo1, Junichi Yamaguchi1
1Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Insights
Intensive systolic blood pressure lowering is safe for patients with coronary artery disease and chronic kidney disease. However, excessive lowering of diastolic blood pressure increases major adverse cardiac events in this high-risk group.
Area of Science:
- Cardiology
- Nephrology
- Hypertension Management
Background:
- Hypertension management is crucial for patients with coronary artery disease (CAD).
- Patients with co-existing chronic kidney disease (CKD) face worse prognoses.
- Limited data exists on blood pressure (BP)-lowering therapy's cardiovascular benefits in CAD and CKD patients.
Purpose of the Study:
- To assess the relationship between achieved BP and major adverse cardiac events (MACE).
- To evaluate high-risk patients with both CAD and CKD.
Main Methods:
- Post-hoc analysis of the HIJ-CREATE trial (n=2049).
- Included 1,002 hypertensive patients with CAD and CKD (eGFR <60 mL/minute/1.73m²).
- Analyzed MACE incidence based on quartiles of achieved systolic and diastolic BP.
Main Results:
- Intensive lowering of diastolic BP was associated with increased MACE in CKD patients.
- Intensive lowering of systolic BP did not increase MACE.
- A "reverse J-shape" curve observed between diastolic BP and MACE incidence.
Conclusions:
- Achieved systolic BP reduction is not linked to increased MACE in hypertensive patients with CAD and CKD.
- Excessive reduction in diastolic BP during antihypertensive treatment correlates with higher MACE rates.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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