Shiraishi J et al. – In the presence or absence of previous coronary artery disease (CAD), valsartan add–on treatment prevented more cardio–cerebrovascular events than conventional non–angiotensin II receptor blocker (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.
- 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.