Advertisement

Cardio-Cerebrovascular Protective Effects of Valsartan in High-Risk Hypertensive Patients With Coronary Artery Disease (from the Kyoto Heart Study)

Published:February 13, 2012DOI:https://doi.org/10.1016/j.amjcard.2011.12.025
      The objective was to examine whether previous coronary artery disease (CAD) influences the add-on effects of the angiotensin II receptor blocker (ARB) valsartan on cardio-cerebrovascular morbidity and mortality in high-risk hypertensive patients who participated in the Kyoto Heart Study. The primary end point was the same as in the main study: a composite of new-onset and/or worsening of cardiovascular and cerebrovascular events. Median follow-up was 3.27 years. According to the presence of previous CAD at baseline, the study population was divided into 2 groups (with CAD, n = 707; without CAD, n = 2,324) in which primary end-point events occurred more frequently in patients with CAD than in patients without CAD (15.1% vs 5.6%, hazard ratio [HR] 2.68, 95% confidence interval [CI] 2.11 to 3.42). Add-on valsartan significantly decreased the occurrence of the primary end-point events in patients with CAD (11.3% vs 19.0%, HR 0.59, 95% CI 0.41 to 0.85) and without CAD (3.7% vs 7.6%, HR 0.49, 95% CI 0.34 to 0.70) compared to non-ARB treatment. In the presence of previous CAD, patients with valsartan add-on treatment had a significantly lower prevalence of angina pectoris and stroke than those with non-ARB treatment, whereas the valsartan add-on effects on angina and stroke were not significant in the absence of CAD. Changes in blood pressure during the follow-up period did not differ significantly between study subgroups. In conclusion, in the presence or absence of previous CAD, valsartan add-on treatment prevented more cardio-cerebrovascular events than conventional non-ARB treatment in high-risk hypertensive patients. In addition, valsartan add-on treatment conferred not only an antianginal effect but also stroke prevention exclusively in hypertensive patients with CAD compared to those without CAD.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sawada T.
        • Yamada H.
        • Dahlöf B.
        • Matsubara H.
        • Kyoto Heart Study Group
        Effects of valsartan on morbidity and mortality in uncontrolled hypertensive patients with high cardiovascular risks: Kyoto Heart study.
        Eur Heart J. 2009; 30: 2461-2469
        • Sawada T.
        • Takahashi T.
        • Yamada H.
        • Dahlöf B.
        • Matsubara H.
        • Kyoto Heart Study Group
        Rationale and design of the Kyoto Heart study: effects of valsartan on morbidity and mortality in uncontrolled hypertensive patients with high risk of cardiovascular events.
        J Hum Hypertens. 2009; 23: 188-195
        • Ueshima K.
        • Yasuno S.
        • Oba K.
        • Fujimoto A.
        • Ogihara T.
        • Saruta T.
        • Nakao K.
        Effects of cardiac complications on cardiovascular events in Japanese high-risk hypertensive patients: subanalysis of the CASE-J trial.
        Circ J. 2009; 73: 1080-1085
        • Ueshima K.
        • Oba K.
        • Yasuno S.
        • Fujimoto A.
        • Tanaka S.
        • Ogihara T.
        • Saruta T.
        • Nakao K.
        Influence of coronary risk factors on coronary events in Japanese high-risk hypertensive patients. - Primary and secondary prevention of ischemic heart disease in a subanalysis of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial.
        Circ J. 2011; 75: 2411-2416
        • Yusuf S.
        • Sleight P.
        • Pogue J.
        • Bosch J.
        • Davies R.
        • Dagenais G.
        Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients.
        N Engl J Med. 2000; 342: 145-153
        • Fox K.M.
        • European Trail on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Investigators
        Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study).
        Lancet. 2003; 362: 782-788
        • Dagenais G.R.
        • Pogue J.
        • Fox K.
        • Simoons M.L.
        • Yusuf S.
        Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials.
        Lancet. 2006; 368: 581-588
        • Bakris G.
        Are there effects of renin-angiotensin system antagonists beyond blood pressure control?.
        Am J Cardiol. 2010; 105: 21A-29A
        • Hoogwerf B.J.
        Renin-angiotensin system blockade and cardiovascular and renal protection.
        Am J Cardiol. 2010; 105: 30A-35A
        • Kasanuki H.
        • Hagiwara N.
        • Hosoda S.
        • Sumiyoshi T.
        • Honda T.
        • Haze K.
        • Nagashima M.
        • Yamaguchi J.
        • Origasa H.
        • Urashima M.
        • Ogawa H.
        • HIJ-CREATE Investigators
        Angiotensin II receptor blocker-based vs. non-angiotensin II receptor blocker-based therapy in patients with angiographically documented coronary artery disease and hypertension: the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease (HIJ-CREATE).
        Eur Heart J. 2009; 30: 1203-1212
        • Yusuf S.
        • Teo K.K.
        • Pogue J.
        • Dyal L.
        • Copland I.
        • Schumacher H.
        • Dagenais G.
        • Sleight P.
        • Anderson C.
        • ONTARGET Investigators
        Telmisartan, ramipril, or both in patients at high risk for vascular events.
        N Engl J Med. 2008; 358: 1547-1559
        • Braunwald E.
        • Domanski M.J.
        • Fowler S.E.
        • Geller N.L.
        • Gersh B.J.
        • Hsia J.
        • Pfeffer M.A.
        • Rice M.M.
        • Rosenberg Y.D.
        • Rouleau J.L.
        • PEACE Trial Investigators
        Angiotensin-converting-enzyme inhibition in stable coronary artery disease.
        N Engl J Med. 2004; 35: 2058-2068