Prevalence and management of hypertension in acute coronary syndrome patients varies by sex: Observations from the Sibrafiban versus aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes (SYMPHONY) randomized clinical trials

Camille G. Frazier, Svati H. Shah, Paul W. Armstrong, Manjushri V. Bhapkar, Darren K McGuire, Zygmunt Sadowski, Arni Kristinsson, Philip E. Aylward, Werner W. Klein, W. Douglas Weaver, L. Kristin Newby

Research output: Contribution to journalArticle

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Abstract

Background: Hypertension affects 1 billion individuals worldwide and is an independent risk factor for death after acute coronary syndromes (ACS). Methods: We examined the prevalence and medical treatment of hypertension among 15 904 ACS patients randomized in the SYMPHONY and 2nd SYMPHONY trials. Analyses were performed overall and according to sex for the United States and across international practice. Multivariable models identified factors associated with use of antihypertensive medication classes and examined the association of hypertension and sex with mortality. Results: In the United States, hypertension was more prevalent in women than in men, overall (63% vs 50%) and within every decile of age. Hypertensive women more often received calcium-channel blockers (35% vs 30%) and diuretics (33% vs 19%) and less often received β-blockers (51% vs 57%). Angiotensin-converting enzyme inhibitor use was similar (35% vs 34%). Women received multiple agents more frequently than did men: 2 agents, 35% vs 30%; ≥3 agents, 16% vs 13%. Female sex independently predicted drug-class use only for diuretics. Mortality was higher in hypertensive women than in hypertensive men; after multivariable adjustment, mortality was similar without evidence of a differential association between hypertension and mortality according to sex. Although there was international variation in the use of individual classes of agents, the overall findings by sex were similar across regions. Conclusion: Hypertension is more prevalent in women than in men with ACS, and its medical management varies by sex, but its association with mortality is similar. Opportunities exist to improve medical therapy and outcomes in women with hypertension.

Original languageEnglish (US)
Pages (from-to)1260-1267
Number of pages8
JournalAmerican Heart Journal
Volume150
Issue number6
DOIs
StatePublished - Dec 2005

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Acute Coronary Syndrome
Aspirin
Randomized Controlled Trials
Hypertension
Mortality
Diuretics
Calcium Channel Blockers
sibrafiban
Angiotensin-Converting Enzyme Inhibitors
Antihypertensive Agents
Therapeutics
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Prevalence and management of hypertension in acute coronary syndrome patients varies by sex : Observations from the Sibrafiban versus aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes (SYMPHONY) randomized clinical trials. / Frazier, Camille G.; Shah, Svati H.; Armstrong, Paul W.; Bhapkar, Manjushri V.; McGuire, Darren K; Sadowski, Zygmunt; Kristinsson, Arni; Aylward, Philip E.; Klein, Werner W.; Weaver, W. Douglas; Newby, L. Kristin.

In: American Heart Journal, Vol. 150, No. 6, 12.2005, p. 1260-1267.

Research output: Contribution to journalArticle

Frazier, Camille G. ; Shah, Svati H. ; Armstrong, Paul W. ; Bhapkar, Manjushri V. ; McGuire, Darren K ; Sadowski, Zygmunt ; Kristinsson, Arni ; Aylward, Philip E. ; Klein, Werner W. ; Weaver, W. Douglas ; Newby, L. Kristin. / Prevalence and management of hypertension in acute coronary syndrome patients varies by sex : Observations from the Sibrafiban versus aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes (SYMPHONY) randomized clinical trials. In: American Heart Journal. 2005 ; Vol. 150, No. 6. pp. 1260-1267.
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abstract = "Background: Hypertension affects 1 billion individuals worldwide and is an independent risk factor for death after acute coronary syndromes (ACS). Methods: We examined the prevalence and medical treatment of hypertension among 15 904 ACS patients randomized in the SYMPHONY and 2nd SYMPHONY trials. Analyses were performed overall and according to sex for the United States and across international practice. Multivariable models identified factors associated with use of antihypertensive medication classes and examined the association of hypertension and sex with mortality. Results: In the United States, hypertension was more prevalent in women than in men, overall (63{\%} vs 50{\%}) and within every decile of age. Hypertensive women more often received calcium-channel blockers (35{\%} vs 30{\%}) and diuretics (33{\%} vs 19{\%}) and less often received β-blockers (51{\%} vs 57{\%}). Angiotensin-converting enzyme inhibitor use was similar (35{\%} vs 34{\%}). Women received multiple agents more frequently than did men: 2 agents, 35{\%} vs 30{\%}; ≥3 agents, 16{\%} vs 13{\%}. Female sex independently predicted drug-class use only for diuretics. Mortality was higher in hypertensive women than in hypertensive men; after multivariable adjustment, mortality was similar without evidence of a differential association between hypertension and mortality according to sex. Although there was international variation in the use of individual classes of agents, the overall findings by sex were similar across regions. Conclusion: Hypertension is more prevalent in women than in men with ACS, and its medical management varies by sex, but its association with mortality is similar. Opportunities exist to improve medical therapy and outcomes in women with hypertension.",
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T1 - Prevalence and management of hypertension in acute coronary syndrome patients varies by sex

T2 - Observations from the Sibrafiban versus aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes (SYMPHONY) randomized clinical trials

AU - Frazier, Camille G.

AU - Shah, Svati H.

AU - Armstrong, Paul W.

AU - Bhapkar, Manjushri V.

AU - McGuire, Darren K

AU - Sadowski, Zygmunt

AU - Kristinsson, Arni

AU - Aylward, Philip E.

AU - Klein, Werner W.

AU - Weaver, W. Douglas

AU - Newby, L. Kristin

PY - 2005/12

Y1 - 2005/12

N2 - Background: Hypertension affects 1 billion individuals worldwide and is an independent risk factor for death after acute coronary syndromes (ACS). Methods: We examined the prevalence and medical treatment of hypertension among 15 904 ACS patients randomized in the SYMPHONY and 2nd SYMPHONY trials. Analyses were performed overall and according to sex for the United States and across international practice. Multivariable models identified factors associated with use of antihypertensive medication classes and examined the association of hypertension and sex with mortality. Results: In the United States, hypertension was more prevalent in women than in men, overall (63% vs 50%) and within every decile of age. Hypertensive women more often received calcium-channel blockers (35% vs 30%) and diuretics (33% vs 19%) and less often received β-blockers (51% vs 57%). Angiotensin-converting enzyme inhibitor use was similar (35% vs 34%). Women received multiple agents more frequently than did men: 2 agents, 35% vs 30%; ≥3 agents, 16% vs 13%. Female sex independently predicted drug-class use only for diuretics. Mortality was higher in hypertensive women than in hypertensive men; after multivariable adjustment, mortality was similar without evidence of a differential association between hypertension and mortality according to sex. Although there was international variation in the use of individual classes of agents, the overall findings by sex were similar across regions. Conclusion: Hypertension is more prevalent in women than in men with ACS, and its medical management varies by sex, but its association with mortality is similar. Opportunities exist to improve medical therapy and outcomes in women with hypertension.

AB - Background: Hypertension affects 1 billion individuals worldwide and is an independent risk factor for death after acute coronary syndromes (ACS). Methods: We examined the prevalence and medical treatment of hypertension among 15 904 ACS patients randomized in the SYMPHONY and 2nd SYMPHONY trials. Analyses were performed overall and according to sex for the United States and across international practice. Multivariable models identified factors associated with use of antihypertensive medication classes and examined the association of hypertension and sex with mortality. Results: In the United States, hypertension was more prevalent in women than in men, overall (63% vs 50%) and within every decile of age. Hypertensive women more often received calcium-channel blockers (35% vs 30%) and diuretics (33% vs 19%) and less often received β-blockers (51% vs 57%). Angiotensin-converting enzyme inhibitor use was similar (35% vs 34%). Women received multiple agents more frequently than did men: 2 agents, 35% vs 30%; ≥3 agents, 16% vs 13%. Female sex independently predicted drug-class use only for diuretics. Mortality was higher in hypertensive women than in hypertensive men; after multivariable adjustment, mortality was similar without evidence of a differential association between hypertension and mortality according to sex. Although there was international variation in the use of individual classes of agents, the overall findings by sex were similar across regions. Conclusion: Hypertension is more prevalent in women than in men with ACS, and its medical management varies by sex, but its association with mortality is similar. Opportunities exist to improve medical therapy and outcomes in women with hypertension.

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