Impact of left ventricular ejection function on blood pressure-lowering therapy in hypertensive patients with coronary artery disease

Abstract

Objective: The prognosis of hypertensive patients with reduced left ventricular ejection fraction (LVEF) is poorer than that with normal LVEF. The influence of LVEF on blood pressure (BP)-lowering therapy remains unclear. The aim of this study was to clarify the impact of LVEF on clinical outcomes of BP-lowering therapy in hypertensive patients with coronary artery disease (CAD).

Methods: This study was a post hoc analysis from Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Heart Disease trial, a total of 2049 hypertensive patients with CAD were included. We analyzed 1849 patients with available LVEF data on enrollment. They were divided into three groups based on LVEF; reduced (<45%, n = 386), intermediate (45-55%, n = 524), and preserved (>55%, n = 999). The 'achieved SBP' was defined as the mean value of SBP in patients who did not experience major adverse cardiac events (MACE) and the mean value of SBP prior to MACE in those who experienced MACE.

Results: During a median follow-up period of 4.2 years, MACE rates were 30.6, 27.6, and 24.0% in the reduced, intermediate, and preserved LVEF groups, respectively. A J-shaped association between achieved SBP and MACE was observed only in the preserved LVEF group [hazard ratio of MACE in patients with lower SBP (achieved SBP < 120 mmHg) was 1.81 (1.13-2.90) compared to reference SBP patients (120 < achieved BP < 130 mmHg)], but not in the reduced or intermediate LVEF groups.

Conclusion: In hypertensive patients with CAD, the goal of BP-lowering therapy should consider LVEF status.