Relationship between the achieved blood pressure and the incidence of cardiovascular events in Japanese hypertensive patients with complications: a sub-analysis of the CASE-J trial

Abstract

Various guidelines for hypertension specify that the target blood pressure (BP) should be below 140/90 mm Hg and that strict control is recommended for patients with cardiovascular risk factors. We examined the relationship between the achieved BP and the incidence of cardiovascular events in hypertensive patients with complications as a sub-analysis of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial. A total of 4703 patients were evaluated for efficacy in the CASE-J trial. In this sub-analysis, 4553 patients had at least one follow-up visit without any cardiovascular events. We examined the relationship between the achieved BP and cardiovascular events in hypertensive patients with type II diabetes mellitus (DM), chronic kidney disease (CKD) or left ventricular hypertrophy (LVH) at baseline. Possible baseline confounders were adjusted by using the multiple Cox regression model. A higher achieved BP was associated with an increased risk of cardiovascular events in hypertensive patients with complications (DM, CKD or LVH). In patients with LVH, who achieved systolic/diastolic BP (SBP/DBP) <130/75-79 mm Hg, the risk of cardiovascular events was reduced to the same level of SBP/DBP <130/75-79 mm Hg in those without LVH. However, the risks of cardiovascular events in patients with DM or CKD, who achieved SBP/DBP <130/75-79 mm Hg, were still significantly higher than in those without DM or CKD. In conclusion, this study extended the significance of BP control in hypertensive patients especially with complications. Further investigation in a large-scale clinical trial is needed to determine the optimal target BP for LVH patients.