Abstract
Background: Control of blood pressure (BP) in patients with underlying coronary artery disease (CAD) provides a decreased risk in morbidity and mortality. According to the US Joint National Committee VII (JNC-7) recommendations, patients with underlying CAD should have goal blood pressures of systolic <130 and diastolic <80. These goals can be attained by using multiple classes of drugs including beta-blockers (BB), angiotensin agonists (ACE-I/ARB), calcium channel blockers (CCB), diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on attaining JNC-7 guidelines for BP in a diverse population of 772 patients undergoing PCI between September 2004 and September 2008 at the Jesse Brown Veterans Hospital in Chicago, IL. Data was collected which compared both BP measurements and antihypertensive regimens pre and post PCI. Results: For the 772 patients, the overall population mean systolic blood pressure (SBP) decreased from 134 to 128mmHg (p < 0.0001) and mean diastolic blood pressure (DBP) decreased from 73 to 70mmHg (p < 0.0001). With regards to JNC-7 guidelines, the percent of patients who reached SBP goals increased from 44 to 54% (340 to 417 of 772) (p < 0.0001) and with DBP goals rose from 72 to 78% (556 to 602 of 772) (p = 0.0031). At 6 months, there was a statistically significant (all p values <0.0001) change in the use of each drug class; the use of ACE-I/ARB increased from 64% (494 out of 772) to 76% (587 of 772) and BB from 73% (564 of 772) to 89% (687 of 772). There was also increased utilization of diuretics 41% (317 of 772) to 43% (332 of 772) and nitrates 23% (178 of 772) to 29% (224 of 772), however a decrease in the use of calcium channel blockers, 34% (262 of 772) to 31% (239 of 772). Conclusions: There was improvement in BP in the six months after PCI and although there were higher rates of attainment of JNC-7 goals for SBP and DBP at six months, overall percentage values are still suboptimal. Additionally, the medication usage improved in most drug classes with exception of calcium channel blockers; however these increases still leave some room for improvement.
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