Author + information
- James Brian Byrd,
- David E. Newby,
- Julie A. Anderson,
- Peter M.A. Calverley,
- Bartolome R. Celli,
- Nicholas J. Cowans,
- Courtney Crim,
- Fernando J. Martinez,
- Jørgen Vestbo,
- Julie Yates and
- Robert D. Brook
Background: High blood pressure (BP) and elevated heart rate increase the risk for cardiovascular disease (CVD) events and all-cause mortality in the general population as well as in patients with established CVD. However, the nature of their associations with health outcomes in patients with chronic obstructive pulmonary disease (COPD) remains poorly described.
Methods: The Study to Understand Mortality and MorbidITy (SUMMIT) was a multicenter randomized double-blind trial in which study endpoints did not differ across treatment groups (inhaled long-acting beta agonist, corticosteroid, combination therapy and placebo) in 16,485 patients (40-80 years old) with moderate COPD who had, or were at high-risk (≥60 years with ≥2 risk factors), for CVD. In post hoc secondary analyses, we evaluated the associations of baseline BP and heart rate among all patients with the time to first composite CVD event (CVD death, myocardial infarction, stroke, unstable angina or transient ischemic attack) and all-cause mortality in adjusted (age, sex, body mass index (BMI), smoking, beta blocker use) Cox models.
Results: Study participants (age: 65 ± 8 years; men: 75%; BMI: 28 ± 6 kg/m2) had an average BP of 133 ± 15/79 ± 9 mm Hg and heart rate of 76 ± 10 beats/minute. 90% had hypertension with 87% receiving drug treatment (34% on a beta blocker). Both high (≥140 mm Hg; Hazard Ratio [HR] 1.27, 95% confidence interval (CI) 1.11-1.44; n=5,944) and low (<115 mm Hg; HR 1.50, 95%CI 1.22-1.83; n=1,394) systolic BP levels were associated with all-cause mortality. Diastolic BP ≥90 mm Hg (HR 1.35, 95%CI 1.15-1.59; n=3,042) and <75 mm Hg (HR 1.22, 95%CI 1.06-1.40; n=4,565) also increased mortality risk. Conversely, increasing heart rates (≥80 beats/min; HR 1.39; 95%CI 1.21-1.59; n=5,927) and pulse pressures (≥60 mm Hg; HR 1.17; 95%CI 1.01-1.35; n=5,590) were more linearly related to all-cause mortality. The risks for CVD events followed similar patterns.
Conclusions: In patients with moderate COPD and heightened CVD risk, the relationships between systolic and diastolic BP levels with all-cause mortality and CVD events were “U”-shaped; whereas increased heart rate and pulse pressure were more linearly related to risk.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Toward Precision Medicine in the Treatment of Elevated Blood Pressure
Abstract Category: 33. Prevention: Hypertension
Presentation Number: 1186-035
- 2017 American College of Cardiology Foundation