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Risk for events after PCI increases in hypertension, high platelet reactivity
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Patients with hypertension and residual high platelet reactivity with clopidogrel had an increased risk for MACE at 2 years after PCI, according to results from the ADAPT-DES study published in The American Journal of Cardiology.
“We already know that hypertension and residual high platelet reactivity are risk factors for thrombotic events, but we show for the first time that the presence of hypertension moderates the effect of residual high platelet reactivity on the risk of thrombotic events,” Björn Redfors, MD, PhD, medical director of the Data Coordinating Center at the Cardiovascular Research Foundation, assistant professor of clinical medicine in the division of cardiology at NewYork-Presbyterian Hospital/Columbia University Medical Center and associate professor of cardiology at Sahlgrenska University Hospital in Gothenburg, Sweden, told Healio. “In other words, even after accounting for the fact that hypertension in and of itself is associated with increased risk, the excess thrombotic risk associated with residual high platelet reactivity is disproportionally high for patients with hypertension.”
Researchers analyzed data from 8,582 patients who underwent PCI with a drug-eluting stent.
Platelet function tests were performed after PCI. In addition, P2Y12 testing was performed at least 6 hours, at least 12 hours or at least 5 days after a loading dose of clopidogrel. At baseline, patients were asked whether they have ever been diagnosed with hypertension.
Follow-up was conducted at 30 days, 1 year and 2 years. MACE was defined as a composite of probable or definite MI, stent thrombosis or cardiac death. High platelet reactivity was defined as P2Y12 reaction units greater than 208.
Of the patients in the study, 79.6% had a history of hypertension. Compared with patients without a history of hypertension, those with a history of hypertension were more likely to be older (64.6 years vs. 59.7 years; P < .0001), more likely to have other CV risk factors and had higher P2Y12 reaction units (190.1 vs. 179.5; P < .0001), the researchers reported.
At 2 years, the hypertension group had higher rates of all-cause death (4.2% vs. 2.5%; P = .001), MACE (7% vs. 4.4%; P < .001) and MI (5.2% vs. 3.2%; P < .001) compared with the nonhypertension group. This group also had higher rates of stent thrombosis (1% vs. 0.5%; P = .059).
There was a significant interaction between hypertension and high platelet reactivity regarding the risk for MACE at 2 years. High platelet reactivity affected patients differently based on whether they had hypertension (HR = 1.38; 95% CI, 1.14-1.68) or did not have hypertension (HR = 0.81; 95% CI, 0.5-1.33).
“From the perspective of the practicing clinician, our results imply that adequate platelet inhibition is particularly important for patients with hypertension, and that optimization of hypertension treatment may be an effective way to reduce thrombotic risk,” Redford said in an interview. “Hypertension is a multifactorial disease, and if future studies can identify the specific hypertension-associated factors responsible for moderating the effect of platelet reactivity on thrombotic risk, then perhaps we could identify a subpopulation of patients with hypertension in whom tailored antiplatelet therapy based on platelet function testing would be warranted.” – by Darlene Dobkowski
For more information:
Björn Redfors, MD, PhD, can be reached at bredfors@crf.org.
Disclosures: The ADAPT-DES study was sponsored by the Cardiovascular Research Foundation with research support from Abbott Vascular, Accumetrics, Biosensors, Boston Scientific, Cordis, Daiichi Sankyo, Eli Lilly, The Medicines Company, Medtronic and Volcano. Redfors reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Editor’s note: On Aug. 21, 2019, this article was corrected to clarify the interaction between hypertension and high platelet reactivity for the risk for MACE at 2 years. The Editors regret the error.
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