Sanjeev Bhavnani, MD, associate professor, division of medicine, University of Connecticut, Hartford, United States, reported results in 1,991 patients with angiographic CAD and diastolic BP<100 mmHg who were treated with amlodipine 10 mg, enalapril 20 mg, or placebo for 2 years. The impact of therapy on the incidence of cardiovascular events was stratified by body mass index (BMI).

"Presently there are no specific recommendations for the treatment of patients with obesity and hypertension," Dr. Bhavnani said.

His team decided to explore the relationship between cardiovascular risk reduction and intensive antihypertensive therapy (aiming to increase blood pressure control beyond "normal" levels) in CAD patients.

The study found that blood pressure lowering with amlodipine and enalapril was similar across BMI groups. Reductions in the cardiovascular event rate with amlodipine were more evident in obese patients (HR = 0.60, P =.005) and were driven by reductions in hospitalization for angina (HR = 0.61, P =.06), revascularization (HR = 0.56, P =.009) and non-fatal myocardial infarction (HR = 0.28, P =.04).

Decreases in blood pressure among obese patients (systolic blood pressure/diastolic blood pressure: amlodipine, 4.4/2.1 mmHg; enalapril: 4.1/2.1 mmHg) were accompanied by relative reductions in cardiovascular events of 35% and 16%, and absolute reductions of 9% and 4% for amlodipine and enalapril, respectively, compared with placebo.

Dr. Bhavnani cautioned that the results may be limited by the fact that the analysis was performed post-hoc and subgroups were not the same size. Also, the study's design does not provide information about the mechanisms of obesity-related risk.

The clinical benefit of intensive blood pressure lowering in patients with established CAD becomes increasingly important in the obese patients, and blood pressure lowering beyond conventional treatment targets may be necessary in these high-risk patients, he said.

Finally, he noted that the findings demonstrate the need for intensive risk modification in the setting of obesity.

The study was sponsored by Pfizer Inc.


[Presentation title: Clinical Benefit of Intensive Blood Pressure Lowering in Obese Patients with Coronary Artery Disease. A CAMELOT Sub-Study. Abstract Number P-66]

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