| Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy. | |
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MedLine Citation:
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PMID: 20670726 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Our understanding of the growing population of very old patients (aged >or=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 >or=50 years. The patients were grouped by age in 10-year increments (aged >or=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. |
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Authors:
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Scott J Denardo; Yan Gong; Wilmer W Nichols; Franz H Messerli; Anthony A Bavry; Rhonda M Cooper-Dehoff; Eileen M Handberg; Annette Champion; Carl J Pepine |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The American journal of medicine Volume: 123 ISSN: 1555-7162 ISO Abbreviation: Am. J. Med. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-30 Completed Date: 2010-08-31 Revised Date: 2011-09-26 |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: United States |
Other Details:
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Languages: eng Pagination: 719-26 Citation Subset: AIM; IM |
Copyright Information:
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Published by Elsevier Inc. |
Affiliation:
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Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA. scott.denardo@medicine.ufl.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Aged, 80 and over Blood Pressure* Coronary Artery Disease / drug therapy, epidemiology* Diastole / physiology Female Humans Hypertension / drug therapy, epidemiology* Male Middle Aged Proportional Hazards Models Systole / physiology Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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K23 HL086558-04/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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