Angiotensin receptor blocker-based therapy and cardiovascular events in hypertensive patients with coronary artery disease and impaired renal function

Authors: Shiga, Tsuyoshi¹; Kasanuki, Hiroshi¹; Hagiwara, Nobuhisa¹; Sumiyoshi, Tetsuya²; Honda, Takashi³; Haze, Kazuo⁴; Takagi, Atsushi¹; Kawana, Masatoshi¹; Origasa, Hideki⁵; Ogawa, Hiroshi¹; For The Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease Hij-Create Investigators,

Source: Blood Pressure, Volume 19, Number 6, December 2010 , pp. 359-365(7)

Publisher: Informa Healthcare

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Abstract:

<title>Abstract</title>

The aim of this study was to assess the effects of angiotensin receptor blocker (ARB)-based therapy on cardiovascular events in high-risk hypertensive patients with coronary artery disease (CAD) and impaired renal function in post hoc analysis of HIJ-CREATE (Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease). Patients (n=2049) were randomly assigned to candesartan-based or non-ARB treatment arms; 1022 patients (age 70±6 years, 28% female) with impaired renal function, defined as creatinine clearance <60 ml/min at baseline. There was no difference in major adverse cardiac event (MACE), a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke and other cardiovascular events requiring hospitalization between the two arms in patients without impaired renal function. However, there was a lower incidence of MACE in the candesartan-based treatment arm than in the non-ARB treatment arm (HR=0.79, 95% CI 0.63-0.99, p=0.039) in patients with impaired renal function. Among the MACE, candesartan-based treatment reduced hospitalization for unstable angina (HR=0.71, 95% CI 0.52-0.96, p=0.028). Although candesartan-based treatment was not superior to non-ARB treatment in prevention of cardiac mortality, ARB-based therapy may be beneficial in reducing risk of coronary events in hypertensive patients with CAD and impaired renal function.

Keywords: Angiotensin receptor blocker; coronary artery disease; hypertension; renal function

Document Type: Research article

DOI: http://dx.doi.org/10.3109/08037051003802475

Affiliations: 1: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan 2: Sakakibara Heart Institute, Tokyo, Japan 3: Saisei-kai Kumamoto Hospital, Kumamoto, Japan 4: Osaka City General Hospital, Osaka, Japan 5: Division of Clinical Epidemiology and Biostatistics, Toyama University, Toyama, Japan

Publication date: 2010-12-01

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Angiotensin receptor blocker-based therapy and cardiovascular events in hypertensive patients with coronary artery disease and impaired renal function

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