Prevalence and management of hypertension in patients with acute coronary syndrome vary with gender: Observations from the Chinese registry of acute coronary events (CRACE)

Lin,Yun; Pan,Weiqi; Ning,Shangqiu; Song,Xiantao; Jin,Zening; Lv,Shuzheng

doi:10.3892/mmr.2013.1461

Prevalence and management of hypertension in patients with acute coronary syndrome vary with gender: Observations from the Chinese registry of acute coronary events (CRACE)

Authors:
- Yun Lin
- Weiqi Pan
- Shangqiu Ning
- Xiantao Song
- Zening Jin
- Shuzheng Lv
View Affiliations

Affiliations: Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, P.R. China
Published online on: May 8, 2013 https://doi.org/10.3892/mmr.2013.1461
Pages: 173-177

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Hypertension affects one billion people worldwide and is an independent risk factor for death after acute coronary syndrome (ACS). The aim of this study was to examine the prevalence and medical treatment of hypertension among 1,301 ACS patients enrolled into the Chinese registry of acute coronary events (CRACE) trial. Analyses were performed by gender, with both genders combined and according to international practice. Multivariable models identified factors associated with use of different classes of antihypertensive medication, and examined the correlation between hypertension and gender with mortality. The use of angiotensin‑converting enzyme inhibitors (ACEI), β-blockers, calcium channel blockers (CCBs) and diuretics increased in both genders during management of presenting ACS. Hypertensive men were more likely to have been receiving β-blockers when they were discharged (77.2%) than women (69.2%). Hypertensive women were more likely to have received diuretics when they were discharged (28.4%) than men (22%). ACEI use increased by ~60% (absolute increase) in both women and men as a result of ACS treatment, but remained similar between the genders, and the same phenomenon was observed in the use of CCBs. Moreover, hypertensive women were less likely to receive evidence‑based medication to treat their acute coronary event than men (for women and men, respectively: β-blocker, 69.2 vs. 77.2%; ACEI, 85.8 vs. 87.5%). Hypertension is more prevalent in women than in men with ACS, and its medical management varies with gender, but it has a similar association with mortality in both genders. Opportunities exist to improve medical therapy and outcomes for women with hypertension.

View Figures

View References

1	World Health Organization. The world health report 2002: reducing risks, promoting healthy life. http://www.who.int/whr/2002. Accessed January 2005
2	Yusuf S, Hawken S, Ounpuu S, et al: Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 364:937–952. 2004. View Article : Google Scholar : PubMed/NCBI
3	Lee KL, Woodlief LH, Topol EJ, et al: Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients GUSTO-I Investigators. Circulation. 91:1659–1668. 1995. View Article : Google Scholar : PubMed/NCBI
4	Newby LK, Bhapkar MV, White HD, et al: Predictors of 90-day outcome in patients stabilized after acute coronary syndromes. Eur Heart J. 24:172–181. 2003. View Article : Google Scholar : PubMed/NCBI
5	Antman EM, Cohen M, Bernink PJ, et al: The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 284:835–842. 2000. View Article : Google Scholar : PubMed/NCBI
6	Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al: A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA. 290:2805–2816. 2003. View Article : Google Scholar
7	AHA, heart disease and stroke statistics - 2005 update. American Heart Association; Dallas, TX, USA: 2004
8	Chobanian AV, Bakris GL, Black HR, et al: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 42:1206–1252. 2003. View Article : Google Scholar
9	Wolz M, Cutler J, Roccella EJ, et al: Statement from the National High Blood Pressure Education Program: prevalence of hypertension. Am J Hypertens. 13:103–104. 2000. View Article : Google Scholar : PubMed/NCBI
10	Vasan RS, Beiser A, Seshadri S, et al: Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA. 287:1003–1010. 2002. View Article : Google Scholar : PubMed/NCBI
11	Rosenthal T and Oparil S: Hypertension in women. J Hum Hypertens. 14:691–704. 2000. View Article : Google Scholar
12	Reis SE, Holubkov R, Conrad Smith AJ, et al: Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study. Am Heart J. 141:735–741. 2001. View Article : Google Scholar : PubMed/NCBI
13	Rosengren A, Wallentin L, Gitt AK, et al: Sex, age, and clinical presentation of acute coronary syndromes. Eur Heart J. 25:663–670. 2004. View Article : Google Scholar : PubMed/NCBI
14	Gulli G, Cemin R, Pancera P, et al: Evidence of parasympathetic impairment in some patients with cardiac syndrome X. Cardiovasc Res. 52:208–216. 2001. View Article : Google Scholar : PubMed/NCBI
15	Iriarte M, Caso R, Murga N, et al: Microvascular angina pectoris in hypertensive patients with left ventricular hypertrophy and diagnostic value of exercise thallium-201 scintigraphy. Am J Cardiol. 75:335–339. 1995. View Article : Google Scholar : PubMed/NCBI
16	Schwartzkopff B, Motz W, Frenzel H, et al: Structural and functional alterations of the intramyocardial coronary arterioles in patients with arterial hypertension. Circulation. 88:993–1003. 1993. View Article : Google Scholar : PubMed/NCBI
17	Jaffe LS and Seely EW: The heterogeneity of the blood pressure response to hormonal contraceptives. Curr Opin Endocrinol Diabetes. 2:257–265. 1995. View Article : Google Scholar
18	Appel LJ, Champagne CM, Harsha DW, et al: Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 289:2083–2093. 2003.PubMed/NCBI
19	Staessen J, Bulpitt CJ, Fagard R, et al: The influence of menopause on blood pressure. J Hum Hypertens. 3:427–433. 1989.
20	McIntyre M, Hamilton CA, Rees DD, et al: Sex differences in the abundance of endothelial nitric oxide in a model of genetic hypertension. Hypertension. 30:1517–1524. 1997. View Article : Google Scholar : PubMed/NCBI
21	Duvernoy C, Martin J, Briesmiester K, et al: Myocardial blood flow and flow reserve in response to hormone therapy in postmenopausal women with risk factors for coronary disease. J Clin Endocrinol Metab. 89:2783–2788. 2004. View Article : Google Scholar : PubMed/NCBI
22	Hajjar I and Kotchen TA: Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA. 290:199–206. 2003.
23	Cushman WC, Ford CE, Cutler JA, et al: Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J Clin Hypertens (Greenwich). 4:393–404. 2002.
24	Mosca L, Manson JE, Sutherland SE, et al: Cardiovascular disease in women: a statement for healthcare professionals from the American Heart Association. Writing Group. Circulation. 96:2468–2482. 1997. View Article : Google Scholar : PubMed/NCBI
25	Mukherjee D, Fang J, Chetcuti S, et al: Impact of combination evidence-based medical therapy on mortality in patients with acute coronary syndromes. Circulation. 109:745–749. 2004. View Article : Google Scholar : PubMed/NCBI
26	Fox KA, Goodman SG, Anderson FA Jr, et al: From guidelines to clinical practice: the impact of hospital and geographical characteristics on temporal trends in the management of acute coronary syndromes. The Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 24:1414–1424. 2003. View Article : Google Scholar
27	Hochman JS, McCabe CH, Stone PH, et al: Outcome and profile of women and men presenting with acute coronary syndromes: a report from TIMI IIIB. TIMI Investigators. Thrombolysis in Myocardial Infarction. J Am Coll Cardiol. 30:141–148. 1997. View Article : Google Scholar : PubMed/NCBI
28	The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb Investigators. A comparison of recombinant hirudin with heparin for the treatment of acute coronary syndromes. N Engl J Med. 335:775–782. 1996. View Article : Google Scholar : PubMed/NCBI
29	Becker RC, Terrin M, Ross R, et al: Comparison of clinical outcomes for women and men after acute myocardial infarction. The Thrombolysis in Myocardial Infarction Investigators. Ann Intern Med. 120:638–645. 1994. View Article : Google Scholar : PubMed/NCBI
30	Tunstall-Pedoe H, Morrison C, Woodward M, et al: Sex differences in myocardial infarction and coronary deaths in the Scottish MONICA population of Glasgow 1985 to 1991. Presentation, diagnosis, treatment, and 28-day case fatality of 3991 events in men and 1551 events in women. Circulation. 93:1981–1992. 1996. View Article : Google Scholar