Treatment effects of renin-angiotensin system inhibitor and calcium channel blocker in patients with coronary artery narrowing (from the Japanese Coronary Artery Disease Study)

• Published in: Heart and vessels Vol. 25; no. 6; pp. 453 - 459
• Main Authors: Fujita, Masatoshi, Sasayama, Shigetake, Terasaki, Fumio, Mitani, Satoko, Morimoto, Tatsuya, Yamazaki, Tsutomu, Hayashi, Doubun, Kohro, Takahide, Okada, Yoshihiro, Nagai, Ryozo
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01-11-2010; Springer Nature B.V
• Subjects: Aged; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antagonist drugs; Antihypertensive Agents - therapeutic use; Biomedical Engineering and Bioengineering; Blood Pressure - drug effects; Calcium Channel Blockers - therapeutic use; Cardiac Surgery; Cardiology; Cardiovascular disease; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Cardiovascular Diseases - prevention & control; Chi-Square Distribution; Clinical outcomes; Coronary Angiography; Coronary Stenosis - complications; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - drug therapy; Coronary Stenosis - mortality; Coronary Stenosis - physiopathology; Drug therapy; Drug Therapy, Combination; Female; Humans; Inhibitor drugs; Japan; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Renin-Angiotensin System - drug effects; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgery; Combination therapy; Renin-angiotensin system inhibitor; Calcium channel blocker; Coronary artery disease
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-010-0012-5

Low-dose antihypertensive drugs in combination are prescribed frequently in clinical practice. Combination treatment is superior to monotherapy with higher doses of each drug in terms of blood pressure reduction and side effects. However, it is unclear whether combination treatment provides additional prognostic benefit beyond the blood pressure lowering effects. We assessed the usefulness of the combined treatment of a renin-angiotensin system inhibitor (RASI) and a calcium channel blocker (CCB) for all cardiovascular events in the Japanese Coronary Artery Disease (JCAD) Study population. In the JCAD Study, which is an observational and non-randomized trial, 13,812 patients with angiographically shown narrowing >50% in ≥1 of 3 major coronary arteries were followed up for a mean of 2.7 years. The primary endpoint of the study was all cardiovascular events. In the present study, baseline covariates possibly influencing the event rate were adjusted between the different treatment groups. There was no statistically significant difference in the event rate between the RASI monotherapy and combined treatment groups, although Kaplan-Meier analysis showed a 23% (
p
 = 0.0003) relative risk reduction with an RASI monotherapy compared with the control group. In conclusion, there may be no additional benefit beyond blood pressure lowering effects in the combination of an RASI and a CCB in patients with angiographically documented CAD.