Coronary artery disease and arterial hypertension: clinical, angiographic and follow-up data

OBJECTIVES: To evaluate how the presence of arterial hypertension affects coronary atherosclerosis and prognosis in patients with, or at high risk of, ischaemic heart disease. DESIGN: Retrospective analysis of clinical records and follow-up data. SETTINGS: Single referral centre for ischaemic heart disease. SUBJECTS: All consecutive patients (n = 1700, 38% with hypertension) undergoing coronary angiography for the evaluation of ischaemic heart disease during 1983-92. RESULTS: On angiography, the likelihood of having three-vessel disease was higher amongst hypertensives (odds ratio = 1.41; 95% confidence interval CI] = 1.08-1.85) after adjustment for age, sex, and angina symptoms. The sum of all visible stenoses (an index of overall atherosclerotic involvement) was 19% higher in hypertensives (262 +/- 204 vs. 220 +/- 194 units, P < 0.005). By multivariate analysis, the presence of hypertension made a modest (+ 28 units), albeit statistically significant, independent contribution to the total atherosclerosis score. On follow-up (median = 96 months), cardiovascular mortality was slightly higher in the hypertensive patients than in the normotensive group (P < 0.05 in a Kaplan-Meier analysis), but a proportional hazard analysis adjusting for age and gender showed no significant independent contribution of hypertension. Hypertensive patients, however, remained at higher risk of non-fatal myocardial infarction following discharge (adjusted odds ratio = 1.21, 95% CI = 1.03-1.46; P < 0.05). CONCLUSIONS: In this referral population, hypertension is a risk factor for presence of three-vessel disease. Distribution, severity and extension of coronary stenosis are similar to those of normotensive patients, and prognosis is only marginally affected.