Goto S, Hirsch AT, Röther J, Aichner FT, Weimar C, ..... Trade â technical school ... College â university ..... Bristol-Myers Squibb and the Waksman Foundation.
Original Article
| doi: 10.1111/j.1365-2796.2009.02198.x
Worse blood pressure control in patients with cerebrovascular or peripheral arterial disease compared with coronary artery disease L. Mechtouff1, E. Touze´1, P. G. Steg2, E. M. Ohman3, S. Goto4, A. T. Hirsch5, J. Ro¨ther6, F. T. Aichner7, C. Weimar8, D. L. Bhatt9, M. J. Alberts10 & J.-L. Mas1, on behalf of the REACH Registry Investigators From the 1Department of Neurology, Hoˆpital Sainte-Anne, Paris-Descartes University, INSERM U894; 2INSERM U-698, Universite´ Paris 7, AP-HP; Paris, France, 3Division of Cardiology, Duke University, Durham, NC, USA, 4Department of Medicine (Cardiology), Tokai University, Isehara, Japan, 5 School of Public Health, University of Minnesota, Minneapolis, MN, USA, 6Johannes Wesling Klinikum, Department of Neurology, Academic Teaching Hospital Hannover Medical School, Minden, Germany, 7Academic Teaching Hospital Wagner-Jauregg, Linz, Austria, 8Department of Neurology, University of Duisburg-Essen, Essen, Germany, 9VA Boston Healthcare System, and Brigham and Women’s Hospital, Boston, MA; and 10 Department of Neurology, Northwestern University Medical School, Chicago, IL; USA1
Abstract. Mechtouff L, Touze´ E, Steg PG, Ohman EM, Goto S, Hirsch AT, Ro¨ther J, Aichner FT, Weimar C, Bhatt DL, Alberts MJ, Mas J-L, on behalf of the REACH Registry Investigators (Paris-Descartes University; Universite´ Paris 7; Paris, France, Duke University, Durham NC, USA, Tokai University, Isehara, Japan, University of Minnesota, Minneapolis, MN, USA, Academic Teaching Hospital Hannover Medical School, Minden, Germany, Academic Teaching Hospital Wagner-Jauregg, Linz, Austria, University of Duisburg-Essen, Essen, Germany, VA Boston Healthcare System, and Brigham and Women’s Hospital, Boston, MA; and Northwestern University Medical School, Chicago, IL; USA). Worse blood pressure control in patients with cerebrovascular or peripheral arterial disease compared with coronary artery disease. J Intern Med 2010; 267: 621–633. Objectives. Poor blood pressure (BP) control is common amongst patients with symptomatic atherothrombotic disease. It is unclear whether BP control and management differ across atherothrombotic disease subtypes. Methods. We analysed the baseline data of 44 984 patients with documented coronary artery disease (CAD) only (n = 30 414), cerebrovascular disease (CVD) only (n = 11 359) and peripheral arterial disease (PAD) only (n = 3211) from the international REduction of Atherothrombosis for Continued Health Registry and investigated the impact of atherothrombotic disease subtype on BP control and use of antihypertensive drugs. Results. The proportion of patients with BP controlled (7 mmol L)1], treated or not); hypertension (previously or currently treated); atrial fibrillation; and smoking status (former or current). Baseline seated systolic and diastolic BP, and most recent available fasting glucose and cholesterol levels were obtained. Treatments taken regularly by the patients, including antiplatelets, oral anticoagulants, lipid-lowering drugs, cardiovascular drugs and anti-diabetic agents, at the time of enrolment were recorded.
L. Mechtouff et al.
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Blood pressure was measured by the practitioner who enrolled the patient at the study enrolment visit. We defined controlled BP as 1 year before enrolment into the registry. PAD patients were more often from Western Europe, current or former smokers, and less likely to have treated hypertension than CVD or CAD patients. BP control Table 2 shows that the proportion of patients with BP < 140 ⁄ 90 mmHg was higher amongst CAD (58.1%) patients than amongst CVD (44.8%) or PAD (38.9%) patients. Similar results were found
BP in atherothrombotic diseases
amongst (Table 2).
patients
with
treated
hypertension
Amongst all patients, those with CAD were more likely to have BP < 140 ⁄ 90 mmHg than those with CVD or PAD. CAD patients were also more likely to have systolic BP < 140 mmHg or diastolic BP < 90 mmHg than CVD or PAD patients (Table 2). The better BP control in CAD patients was observed consistently in all world regions (Fig. 1a), although the difference in the proportion of patients with BP < 140 ⁄ 90 mmHg between CAD and CVD populations was lower in North America than in other world regions, mainly resulting from a higher proportion of CVD patients with controlled BP in North America compared with other world regions. Figure 1b shows that patients with CAD had better BP control than those with CVD regardless of age, gender, time since vascular event, and diabetic status. Women with CAD were less likely to have BP < 140 ⁄ 90 mmHg than men with CAD, whereas there was no difference between the sexes in CVD or PAD patients. Consequently, the higher proportion of patients with BP < 140 ⁄ 90 mmHg amongst CAD patients compared with CVD or PAD patients was smaller in women than in men. The proportion of patients with BP < 140 ⁄ 90 mmHg decreased slightly with age in CAD and PAD patients, whereas there was no such trend in CVD patients. Accordingly, the difference in the proportion of patients with BP < 140 ⁄ 90 mmHg between CAD and CVD populations tended to decrease with age (P for trend
