Angiotensin receptor blocker-based therapy and cardiovascular events in hypertensive patients with coronary artery disease and impaired renal function

Figures & data

Table I. Clinical characteristics.

	Creatinine clearance ≥60 ml/min			Creatinine clearance <60 ml/min
Variable	Candesartan-based (n=515)	Non-ARB (n=512)	p-value	Candesartan-based (n=509)	Non-ARB (n=513)	p-value
Age (years)	59±9	60 ±8	0.320	70±6	70±6	0.448
Female sex	50 (9.7%)	68 (13.3%)	0.073	136 (26.7%)	151 (29.4%)	0.334
Diagnosis
Acute coronary syndrome	185 (36.0%)	199 (38.9%)	0.341	160 (31.4%)	178 (34.7%)	0.268
Revascularization
PCI	432 (83.9%)	421 (82.2%)	0.479	418 (82.1%)	422 (82.3%)	0.954
CABG	39 (7.6%)	40 (7.8%)	0.885	85 (16.7%)	72 (14.0%)	0.238
Medical history
Dyslipidaemia	306 (59.4%)	320 (62.5%)	0.311	297 (58.3%)	292 (56.9%)	0.644
Diabetes mellitus	193 (37.4%)	200 (39.1%)	0.601	185 (36.3%)	201 (39.2%)	0.350
Current smoker	167 (32.4%)	155 (30.3%)	0.457	95 (18.7%)	92 (17.9%)	0.763
Family history of CAD	109 (21.2%)	140 (27.3%)	0.021	104 (20.4%)	100 (19.5%)	0.707
Cerebrovascular disease	41 (8.0%)	33 (6.4%)	0.348	70 (13.8%)	61 (11.9%)	0.373
Peripheral vascular disease	12 (2.3%)	7 (1.4%)	0.252	25 (4.9%)	19 (3.7%)	0.342
Atrial fibrillation	24 (4.7%)	31 (6.1%)	0.321	34 (6.7%)	46 (9.0%)	0.174
Previous MI	206 (40.0%)	180 (35.2%)	0.109	199 (39.1%)	193 (37.6%)	0.628
NYHA functional class			0.768			0.056
I	423 (82.1%)	417 (81.4%)		378 (74.3%)	409 (79.7%)
II	74 (14.4%)	75 (14.6%)		111 (21.8%)	80 (15.6%)
III	10 (1.9%)	10 (2.0%)		9 (1.8%)	12 (2.3%)
IV	8 (1.6%)	10 (2.0%)		11 (2.2%)	12 (2.3%)
Body mass index (kg/m^2)	25.7±2.8	25.8±3.0	0.327	23.5±2.6	23.5±2.7	0.848
Systolic blood pressure (mmHg)	135±18	134±17	0.931	136±19	137±17	0.305
Diastolic blood pressure (mmHg)	77±13	77±11	0.806	74±11	75±12	0.488
Heart rate (beats/min)	70±12	69±10	0.121	69 ±11	69±11	0.920
LVEF (%)	54±11	55±11	0.146	53 ±11	55±12	0.019
Total cholesterol (mg/dl)	196±35	196±37	0.822	190±34	189±32	0.533
Triglyceride (mg/dl)*	139 [102–197]	137 [95–194]	0.563	120 [90–175]	115 [85–158]	0.135
HDL-cholesterol (mg/dl)	44±12	44±11	0.760	45±12	45±13	0.914
C-reactive protein (mg/dl)*	0.2 [0.1–0.3]	0.2 [0.1–0.4]	0.856	0.2 [0.1–0.4]	0.2 [0.1–0.4]	0.308
Creatinine clearance (ml/min)	78±16	77±15	0.225	47±8	47 ± 9	0.866
Medications
ACE inhibitors	1 (0.2%)	361 (70.5%)	<0.001	7 (1.1%)	362 (70.6%)	<0.001
Calcium-channel blockers	225 (43.7%)	269 (52.5%)	0.005	231 (45.4%)	305 (59.5%)	<0.001
Beta-blockers	237 (46.0%)	246 (48.0%)	0.515	226 (44.4%)	260 (50.7%)	0.044
Diuretics	34 (6.6%)	33 (6.4%)	0.919	68 (13.4%)	49 (9.6%)	0.056
Statins	250 (48.5%)	237 (46.3%)	0.469	209 (41.1%)	210 (40.9%)	0.968
Nitrates	240 (46.6%)	250 (48.8%)	0.475	262 (51.5%)	276 (53.8%)	0.456
Aspirin	473 (91.8%)	469 (91.6%)	0.888	473 (92.9%)	466 (90.8%)	0.222
Dose of candesartan
<8 mg daily	373 (72.4%)			401 (78.3%)
≥8 mg daily	142 (27.6%)			111 (21.7%)
Follow-up period (months)*	4.2 [3.5–4.8]	4.1 [3.4–4.9]	0.565	4.3 [3.5–4.9]	4.3 [3.4–4.9]	0.995

Values are n (%) or mean±SD. *Median [interquartile range]. ARB, angiotensin receptor blocker; PCI, Percutaneous coronary intervention; CABG, Coronary artery bypass grafting; CAD, coronary artery disease; MI, myocardial infarction; NYHA, New York Heart Association; LVEF, left ventricular ejection fraction; HDL, high-density lipoprotein; ACE, angiotensin-converting enzyme.

Figure 1. Kaplan–Meier curve for primary endpoint (major adverse cardiovascular event) in patients with creatinine clearance ≥60 ml/min and with creatinine clearance <60 ml/min.

Figure 2. Systolic and diastolic blood pressures in candesartan-based and non-ARB treatment arms in patients with creatinine clearance <60 ml/min. Error bars indicate standard deviation. p-values were obtained by a test of trend profile using a mixed model. ARB, angiotensin receptor blocker.

Figure 3. Hazard ratio for primary and secondary endpoints in patients with creatinine clearance <60 ml/min. ARB, angiotensin receptor blocker, PCI, percutaneous coronary intervention, CABG, coronary artery bypass grafting, MI, myocardial infarction.