Objective: To examine the effects of nifedipine GITS on clinical outcome in patients with concurrent stable angina and hypertension. Methods: Data from the double-blind placebo-controlled ACTION trial was stratified f...Objective: To examine the effects of nifedipine GITS on clinical outcome in patients with concurrent stable angina and hypertension. Methods: Data from the double-blind placebo-controlled ACTION trial was stratified for hypertension(blood pressure ≥140/90 mmHg), at baseline. Results: A total of 52%of 7665 ACTION patients were hypertensive. Some 80%were on a βblocker; hypertensives were more often treated with other blood pressure-lowering drugs. Mean baseline blood pressure was 122/74 mmHg among normotensives and 151/85 mmHg among hypertensives. Follow-up blood pressures were reduced by nifedipine(P< 0.001) on the average by 3.9/2.4 and 6.6/3.5 mmHg among normotensives and hypertensives, respectively. Nifedipine GITS significantly(P< 0.05) reduced the combined incidence of all-cause mortality, myocardial infarction, refractory angina, heart failure, stroke and peripheral revascularization by 13%in hypertensives only. Nifedipine significantly reduced the incidence of any stroke or transient ischemic attack by almost 30%in both subgroups and the need for coronary angiography by 21%in normotensives and 16%in hypertensives. Among hypertensives, the incidence of new overt heart failure was significantly reduced by 38%and of debilitating stroke by 33%. Among normotensives, the need for coronary bypass grafting was significantly reduced by 32%. Nifedipine did not affect all-cause death, cardiovascular death and myocardial infarction in either normo-or hypertensives, but increased the need for peripheral revascularization. Conclusion: The salutary effects of the addition of nifedipine GITS to the basic regimen of patients with concurrent stable symptomatic coronary artery disease and hypertension emphasize the need for blood pressure control.展开更多
Objective: To derive a risk score for the combination of death from all causes, myocardial infarction, and disabling stroke in patients with stable symptomatic angina who require treatment for angina and have preserve...Objective: To derive a risk score for the combination of death from all causes, myocardial infarction, and disabling stroke in patients with stable symptomatic angina who require treatment for angina and have preserved left ventricular function. Design: Multivariate Cox regression analysis of data from a large multicentre trial. Setting: Outpatient cardiology clinics in western Europe, Israel, Canada, Australia, and New Zealand. Participants: 7311 patients with all required data available. Main outcome measure: Death from any cause or myocardial infarction or disabling stroke during a mean follow-up of 4.9 years. Results: 1063 patients either died from any cause or sustained myocardial infarction or disabling stroke. The five year risk of this composite ranged from 4% for patients in the lowest tenth of risk to 35% for patients in the highest tenth. The risk score combines 16 routinely available clinical variables(in order of decreasing contribution): age, left ventricular ejection fraction, smoking, white blood cell count, diabetes, casual blood glucose concentration, creatinine concentration, previous stroke, at least one angina attack a week, coronary angiographic findings(if available), lipid lowering treatment, QT interval, systolic blood pressure ≥ 155 mm Hg, number of drugs used for angina, previous myocardial infarction, and sex. Fitting the same model separately to all cause death, myocardial infarction, and stroke gave similar results. The risk score did not seem to predict the nature of the event(death in 39% , myocardial infarction in 46% , and disabling stroke in 15% ) or the incidence of angiography or revascularisation, which occurred in 29% of patients. Conclusion: This risk score is an objective aid in deciding on further management of patients with stable angina with the aim of reducing serious outcome events. The score can also be used in planning future trials.展开更多
文摘Objective: To examine the effects of nifedipine GITS on clinical outcome in patients with concurrent stable angina and hypertension. Methods: Data from the double-blind placebo-controlled ACTION trial was stratified for hypertension(blood pressure ≥140/90 mmHg), at baseline. Results: A total of 52%of 7665 ACTION patients were hypertensive. Some 80%were on a βblocker; hypertensives were more often treated with other blood pressure-lowering drugs. Mean baseline blood pressure was 122/74 mmHg among normotensives and 151/85 mmHg among hypertensives. Follow-up blood pressures were reduced by nifedipine(P< 0.001) on the average by 3.9/2.4 and 6.6/3.5 mmHg among normotensives and hypertensives, respectively. Nifedipine GITS significantly(P< 0.05) reduced the combined incidence of all-cause mortality, myocardial infarction, refractory angina, heart failure, stroke and peripheral revascularization by 13%in hypertensives only. Nifedipine significantly reduced the incidence of any stroke or transient ischemic attack by almost 30%in both subgroups and the need for coronary angiography by 21%in normotensives and 16%in hypertensives. Among hypertensives, the incidence of new overt heart failure was significantly reduced by 38%and of debilitating stroke by 33%. Among normotensives, the need for coronary bypass grafting was significantly reduced by 32%. Nifedipine did not affect all-cause death, cardiovascular death and myocardial infarction in either normo-or hypertensives, but increased the need for peripheral revascularization. Conclusion: The salutary effects of the addition of nifedipine GITS to the basic regimen of patients with concurrent stable symptomatic coronary artery disease and hypertension emphasize the need for blood pressure control.
文摘Objective: To derive a risk score for the combination of death from all causes, myocardial infarction, and disabling stroke in patients with stable symptomatic angina who require treatment for angina and have preserved left ventricular function. Design: Multivariate Cox regression analysis of data from a large multicentre trial. Setting: Outpatient cardiology clinics in western Europe, Israel, Canada, Australia, and New Zealand. Participants: 7311 patients with all required data available. Main outcome measure: Death from any cause or myocardial infarction or disabling stroke during a mean follow-up of 4.9 years. Results: 1063 patients either died from any cause or sustained myocardial infarction or disabling stroke. The five year risk of this composite ranged from 4% for patients in the lowest tenth of risk to 35% for patients in the highest tenth. The risk score combines 16 routinely available clinical variables(in order of decreasing contribution): age, left ventricular ejection fraction, smoking, white blood cell count, diabetes, casual blood glucose concentration, creatinine concentration, previous stroke, at least one angina attack a week, coronary angiographic findings(if available), lipid lowering treatment, QT interval, systolic blood pressure ≥ 155 mm Hg, number of drugs used for angina, previous myocardial infarction, and sex. Fitting the same model separately to all cause death, myocardial infarction, and stroke gave similar results. The risk score did not seem to predict the nature of the event(death in 39% , myocardial infarction in 46% , and disabling stroke in 15% ) or the incidence of angiography or revascularisation, which occurred in 29% of patients. Conclusion: This risk score is an objective aid in deciding on further management of patients with stable angina with the aim of reducing serious outcome events. The score can also be used in planning future trials.
