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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Association Between Hypertension, Platelet Reactivity, and the Risk of Adverse Events After Percutaneous Coronary
Björn Redfors1, Shmuel Chen2, Ori Ben-Yehuda2
1Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Insights
High platelet reactivity (HPR) on clopidogrel increases major adverse cardiac events (MACE) after coronary stenting, especially in patients with hypertension. Hypertension exacerbates the risk associated with HPR following percutaneous coronary intervention.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Hypertension is linked to endothelial dysfunction and increased thrombosis risk.
- Platelet reactivity plays a crucial role in thrombotic events post-percutaneous coronary intervention (PCI).
- Residual high platelet reactivity (HPR) on clopidogrel is a known risk factor for adverse outcomes after PCI.
Purpose of the Study:
- To evaluate if the risk of major adverse cardiac events (MACE) associated with HPR after PCI differs between hypertensive and normotensive patients.
- To investigate the interaction between hypertension and HPR on MACE risk in patients treated with drug-eluting stents (DES).
Main Methods:
- Analysis of data from the prospective, multicenter ADAPT-DES registry.
- HPR was defined as P2Y12 reaction units (PRU) >208 using the VerifyNow assay.
- Multivariable Cox regression analyzed the association between HPR and 2-year MACE risk, stratified by hypertension status.
Main Results:
- A history of hypertension was present in 79.6% of the 8582 patients.
- Patients with hypertension were older, had more risk factors, and higher PRU compared to those without.
- Hypertensive patients had significantly higher 2-year MACE rates (7.0% vs 4.4%), including cardiac death and myocardial infarction.
- A significant interaction was found: HPR increased MACE risk in hypertensive patients (HR 1.38) but not in normotensive patients (HR 0.81).
Conclusions:
- Following successful PCI with DES, patients with both hypertension and residual HPR on clopidogrel face increased MACE risk.
- The adverse impact of HPR on MACE risk is significantly greater in patients with hypertension.
- These findings highlight the importance of managing platelet reactivity in hypertensive patients undergoing PCI.
Abstract:
Hypertension is associated with vascular and endothelial dysfunction that may result in a greater propensity for reactive platelets to cause thrombosis. We sought to assess whether the risk of major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) in patients with on-clopidogrel residual high platelet reactivity (HPR) varies in patients with versus without hypertension. Assessment of dual antiplatelet therapy with drug eluting stents (ADAPT-DES) was a prospective, multicenter registry of patients successfully treated with coronary drug-eluting stents (DES). HPR was defined as P2Y12 reaction units (PRU) >208, as assessed by the VerifyNow point-of-care assay. Multivariable Cox proportional hazards regression was used to assess whether the adjusted association between HPR and 2-year risk of MACE (cardiac death, myocardial infarction [MI], or stent thrombosis) was different in patients with versus without hypertension. A total of 6833 of 8582 patients (79.6%) had a history of hypertension. Patients with compared with those without hypertension were older, more likely to have other cardiovascular risk factors, and had higher PRU (190.1 ± 97.3 vs 179.5 ± 94.3; p <0.0001). Patients with hypertension had significantly higher 2-year rates of MACE (7.0% vs 4.4%, p <0.001), all-cause death (4.2% vs 2.5%, p = 0.001), and MI (5.2% vs 3.2%, p <0.001), and had nominally higher rates of stent thrombosis (1.0% vs 0.5%, p = 0.059). A significant interaction was present between hypertension and HPR regarding 2-year MACE risk (adjusted hazard ratio for HPR vs no HPR 1.38, 95% confidence interval 1.14 to 1.68 for patients with hypertension vs 0.81, 95% confidence interval 0.50 to 1.33 for patients without hypertension, p = 0.046). In conclusion, following successful PCI with DES, 2-year MACE rates are increased in patients with both hypertension and residual HPR on clopidogrel. HPR had a greater effect on the risk of adverse events among patients with versus without hypertension.
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