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Impact of Visit-to-Visit Variability and Systolic Blood Pressure Control on Subsequent Outcomes in Hypertensive Patients With Coronary Artery Disease (from the HIJ-CREATE Substudy)

      Although visit-to-visit variability in systolic blood pressure (BP) is a strong predictor of stroke, the impact on subsequent major adverse cardiac events (MACEs) in patients with coronary artery disease (CAD) in terms of secondary prevention remains unclear. The aim of this study was to clarify the prognostic significance of visit-to-visit variability in systolic BP on subsequent MACE in hypertensive patients with CAD. In the Heart Institute of Japan Candesartan Randomised Trial for Evaluation in Coronary Artery Disease, a total of 2,049 hypertensive patients with CAD were enrolled. Incidence of MACEs in addition to biochemistry tests and office BP were determined during follow-up. Achieved BP was defined as the mean value of systolic BP in patients who did not experience MACE and the mean value of systolic BP before MACE in those who experienced MACE during follow-up. In the present study, 1,734 patients had multiple follow-up visits (≥3 times) until their final follow-up. During a median follow-up of 4.2 years, the primary outcome occurred in 317 patients (18.3%). Visit-to-visit variability of systolic BP was defined as the SD. Participants were divided into equal quartiles based on the mean systolic BP during follow-up and visit-to-visit variability of systolic BP, respectively. Although there was no relation between visit-to-visit variability of systolic BP and the incidence of MACE, the highest quartile based on mean systolic BP showed a significant relation with subsequent MACE. In conclusion, in hypertensive patients with CAD, inadequate BP control is a strong predictor of subsequent MACE, whereas visit-to-visit variability of systolic BP is not.
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