Impact of percutaneous coronary intervention on Quality of Life in Patients with resistant hypertension
DOI:
https://doi.org/10.5281/zenodo.22814718Keywords:
resistant hypertension, percutaneous coronary intervention, quality of life, coronary artery disease, blood pressureAbstract
Background: Resistant hypertension frequently coexists with obstructive coronary artery disease, and whether percutaneous coronary intervention (PCI) meaningfully improves quality of life (QoL) in this overlap population remains incompletely defined.
Objective: This review synthesizes evidence on PCI's effect on quality of life and blood pressure trajectory in patients with resistant hypertension and coronary artery disease, situating revascularization within the resistant-hypertension management pathway.
Methods: We reviewed randomized ischemia trials with quality-of-life substudies, resistant-hypertension pharmacotherapy and device trials, and cohorts linking revascularization status to Seattle Angina Questionnaire and health-utility outcomes.
Findings: PCI produces early, durable improvements in angina-specific quality of life relative to medical therapy alone, most pronounced with frequent baseline angina, while its effect on blood pressure is modest; resistant hypertension amplifies cardiovascular risk independent of coronary anatomy, and spironolactone, renal denervation, and structured regimens lower blood pressure with variable quality-of-life benefit.
Conclusions: PCI relieves angina and improves disease-specific quality of life without substituting for resistant-hypertension therapy, supporting a combined strategy addressing ischemic burden and the hypertensive substrate together.
References
Calhoun, D.A., Jones, D., Textor, S., Goff, D.C., Murphy, T.P., Toto, R.D., et al. (2008) Resistant hypertension: diagnosis, evaluation, and treatment. Circulation, 117(25): e510-e526. DOI: 10.1161/CIRCULATIONAHA.108.189141
Carey, R.M., Calhoun, D.A., Bakris, G.L., Brook, R.D., Daugherty, S.L., Dennison-Himmelfarb, C.R., et al. (2018) Resistant hypertension: detection, evaluation, and management. Hypertension, 72(5): e53-e90. DOI: 10.1161/HYP.0000000000000084
Persell, S.D. (2011) Prevalence of resistant hypertension in the United States, 2003-2008. Hypertension, 57(6): 1076-1080. DOI: 10.1161/HYPERTENSIONAHA.111.170308
Judd, E., Calhoun, D.A. (2014) Apparent and true resistant hypertension: definition, prevalence and outcomes. Journal of Human Hypertension, 28(8): 463-468. DOI: 10.1038/jhh.2013.99
Daugherty, S.L., Powers, J.D., Magid, D.J., Tavel, H.M., Masoudi, F.A., Margolis, K.L., et al. (2012) Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation, 125(13): 1635-1642. DOI: 10.1161/CIRCULATIONAHA.111.068064
Rosendorff, C., Black, H.R., Cannon, C.P., Gersh, B.J., Gore, J., Izzo, J.L., et al. (2007) Treatment of hypertension in patients with coronary artery disease. Circulation, 115(21): 2761-2788. DOI: 10.1161/CIRCULATIONAHA.107.183885
Messerli, F.H., Williams, B., Ritz, E. (2007) Essential hypertension. Lancet, 370(9587): 591-603. DOI: 10.1016/S0140-6736(07)61299-9
Pierdomenico, S.D., Lapenna, D., Bucci, A., Di Tommaso, R., Di Mascio, R., Manente, B.M., et al. (2005) Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. American Journal of Hypertension, 18(11): 1422-1428. DOI: 10.1016/j.amjhyper.2005.05.014
Spertus, J.A., Winder, J.A., Dewhurst, T.A., Deyo, R.A., Prodzinski, J., McDonell, M., et al. (1995) Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. Journal of the American College of Cardiology, 25(2): 333-341. DOI: 10.1016/0735-1097(94)00397-9
Ware, J.E., Sherbourne, C.D. (1992) The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6): 473-483. DOI: 10.1097/00005650-199206000-00002
Spertus, J.A., Jones, P., McDonell, M., Fan, V., Fihn, S.D. (2002) Health status predicts long-term outcome in outpatients with coronary disease. Circulation, 106(1): 43-49. DOI: 10.1161/01.CIR.0000020688.24874.90
Rumsfeld, J.S., MaWhinney, S., McCarthy, M., Shroyer, A.L., VillaNueva, C.B., O'Brien, M., et al. (1999) Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. JAMA, 281(14): 1298-1303. DOI: 10.1001/jama.281.14.1298
Spertus, J.A., Salisbury, A.C., Jones, P.G., Conaway, D.G., Thompson, R.C. (2004) Predictors of quality-of-life benefit after percutaneous coronary intervention. Circulation, 110(25): 3789-3794. DOI: 10.1161/01.CIR.0000150392.70749.C7
Boden, W.E., O'Rourke, R.A., Teo, K.K., Hartigan, P.M., Maron, D.J., Kostuk, W.J., et al. (2007) Optimal medical therapy with or without PCI for stable coronary disease. New England Journal of Medicine, 356(15): 1503-1516. DOI: 10.1056/NEJMoa070829
Weintraub, W.S., Spertus, J.A., Kolm, P., Maron, D.J., Zhang, Z., Jurkovitz, C., et al. (2008) Effect of PCI on quality of life in patients with stable coronary disease. New England Journal of Medicine, 359(7): 677-687. DOI: 10.1056/NEJMoa072771
Maron, D.J., Hochman, J.S., Reynolds, H.R., Bangalore, S., O'Brien, S.M., Boden, W.E., et al. (2020) Initial invasive or conservative strategy for stable coronary disease. New England Journal of Medicine, 382(15): 1395-1407. DOI: 10.1056/NEJMoa1915922
Spertus, J.A., Jones, P.G., Maron, D.J., O'Brien, S.M., Reynolds, H.R., Rosenberg, Y., et al. (2020) Health-status outcomes with invasive or conservative care in coronary disease. New England Journal of Medicine, 382(15): 1408-1419. DOI: 10.1056/NEJMoa1916370
Al-Lamee, R., Thompson, D., Dehbi, H.M., Sen, S., Tang, K., Davies, J., et al. (2018) Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet, 391(10115): 31-40. DOI: 10.1016/S0140-6736(17)32714-9
Rajkumar, C.A., Foley, M.J., Ahmed-Jushuf, F., Nowbar, A.N., Simader, F.A., Davies, J.R., et al. (2023) A placebo-controlled trial of percutaneous coronary intervention for stable angina. New England Journal of Medicine, 389(25): 2319-2330. DOI: 10.1056/NEJMoa2310610
Maddox, T.M., Stanislawski, M.A., Grunwald, G.K., Bradley, S.M., Ho, P.M., Tsai, T.T., et al. (2014) Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA, 312(17): 1754-1763. DOI: 10.1001/jama.2014.14681
Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E., Collins, K.J., Dennison Himmelfarb, C., et al. (2018) 2017 ACC/AHA/ AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6): e13-e115. DOI: 10.1161/HYP.0000000000000065
Rimoldi, S.F., Scherrer, U., Messerli, F.H. (2014) Secondary arterial hypertension: when, who, and how to screen? World Journal of Cardiology, 6(5): 269-274. DOI: 10.4330/wjc.v6.i5.269
Calhoun, D.A. (2006) Aldosteronism and hypertension. Clinical Journal of the American Society of Nephrology, 1(5): 1039-1045. DOI: 10.2215/CJN.01060306
Poulter, N.R., Prabhakaran, D., Caulfield, M. (2015) Hypertension. Lancet, 386(9995): 801-812. DOI: 10.1016/S0140-6736(14)61468-9
Muntner, P., Hardy, S.T., Fine, L.J., Jaeger, B.C., Wozniak, G., Levitan, E.B., et al. (2020) Trends in blood pressure control among US adults with hypertension. JAMA, 324(12): 1190-1200. DOI: 10.1001/jama.2020.14545
Williams, B., MacDonald, T.M., Morant, S., Webb, D.J., Sever, P., McInnes, G., et al. (2015) Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2). Lancet, 386(10008): 2059-2068. DOI: 10.1016/S0140-6736(15)00257-3
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., et al. (2018) 2018 ESC/ESH guidelines for the management of arterial hypertension. European Heart Journal, 39(33): 3021-3104. DOI: 10.1093/eurheartj/ehy339
Bhatt, D.L., Kandzari, D.E., O'Neill, W.W., D'Agostino, R., Flack, J.M., Katzen, B.T., et al. (2014) A controlled trial of renal denervation for resistant hypertension. New England Journal of Medicine, 370(15): 1393-1401. DOI: 10.1056/NEJMoa1402670
Kandzari, D.E., Böhm, M., Mahfoud, F., Townsend, R.R., Weber, M.A., Pocock, S., et al. (2018) Effect of renal denervation on blood pressure in the presence of antihypertensive drugs (SPYRAL HTN-ON MED). Lancet, 391(10137): 2346-2355. DOI: 10.1016/S0140-6736(18)30951-6
Townsend, R.R., Mahfoud, F., Kandzari, D.E., Kario, K., Pocock, S., Weber, M.A., et al. (2017) Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED). Lancet, 390(10108): 2160-2170. DOI: 10.1016/S0140-6736(17)32281-X
Böhm, M., Kario, K., Kandzari, D.E., Mahfoud, F., Weber, M.A., Schmieder, R.E., et al. (2020) Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal). Lancet, 395(10234): 1444-1451. DOI: 10.1016/S0140-6736(20)30554-7
Azizi, M., Schmieder, R.E., Mahfoud, F., Weber, M.A., Daemen, J., Davies, J., et al. (2018) Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO). Lancet, 391(10137): 2335-2345. DOI: 10.1016/S0140-6736(18)31082-1
Weber, M.A., Kirtane, A.J., Weir, M.R., Radhakrishnan, J., Das, T., Kocheril, A., et al. (2019) Renal denervation for treating hypertension: current scientific and clinical evidence. JACC: Cardiovascular Interventions, 12(12): 1095-1105. DOI: 10.1016/j.jcin.2018.10.056
Kario, K., Ogawa, H., Okumura, K., Okura, T., Saito, S., Ueno, T., et al. (2015) SYMPLICITY HTN-Japan: first randomized controlled trial of catheter-based renal denervation in Asian patients. Circulation Journal, 79(6): 1222-1229. DOI: 10.1253/circj.CJ-15-0150
Ogihara, T., Kikuchi, K., Matsuoka, H., Fujita, T., Higaki, J., Horiuchi, M., et al. (2009) The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2009). Hypertension Research, 32(1): 3-107. DOI: 10.1038/hr.2009.34
Pepine, C.J., Handberg, E.M., Cooper-DeHoff, R.M., Marks, R.G., Kowey, P., Messerli, F.H., et al. (2003) A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. JAMA, 290(21): 2805-2816. DOI: 10.1001/jama.290.21.2805
Fihn, S.D., Gardin, J.M., Abrams, J., Berra, K., Blankenship, J.C., Dallas, A.P., et al. (2012) 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation, 126(25): e354-e471. DOI: 10.1161/CIR.0b013e318277d6a0
Pitt, B., Zannad, F., Remme, W.J., Cody, R., Castaigne, A., Perez, A., et al. (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. New England Journal of Medicine, 341(10): 709-717. DOI: 10.1056/NEJM199909023411001
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