Uncontrolled admission blood pressure was present in 33.7% of elective PCI patients, who received fewer antihypertensive classes and less often diuretics (32.9% vs. 46.7%; p=0.008).
Cohort (n=433)
A high proportion of patients undergoing elective PCI have uncontrolled blood pressure and apparent treatment-resistant hypertension despite multidrug therapy, highlighting a need for regimen optimization.
Absolute Event Rate: 32.9% vs 46.7%
p-value: p=0.008
Objective: To describe admission blood pressure control and baseline antihypertensive therapy, including drug choices and dose intensity, in patients undergoing elective percutaneous coronary intervention. Design and method: Retrospective cohort of consecutive patients undergoing elective percutaneous coronary intervention for chronic coronary syndrome in 2019 (433 patients). Uncontrolled blood pressure was defined as systolic at least 140 mmHg and/or diastolic at least 90 mmHg. Baseline antihypertensive therapy and daily doses were obtained from medical history; missing entries were treated as not prescribed. Dose intensity was low (up to 25 percent), medium (26 to 99 percent) or high (100 percent or more) of maximal recommended daily dose. Results: Mean age was 73.3 ± 9.9 years and 329 (76.0%) were men. Mean admission blood pressure was 131.9 ± 15.6/77.0 ± 8.6 mmHg; uncontrolled blood pressure was present in 146/433 (33.7%). Baseline therapy included beta-blockers 327/433 (75.5%), angiotensin-converting enzyme inhibitors 240/433 (55.4%), angiotensin receptor blockers 90/433 (20.8%), calcium channel blockers 155/433 (35.8%), diuretics 182/433 (42.0%), and mineralocorticoid receptor antagonists 69/433 (15.9%). Median number of antihypertensive classes was 3 (interquartile range 2 to 3); 217/433 (50.1%) received three or more classes and 105/433 (24.2%) four or more classes. Apparent treatment resistant hypertension was present in 122/433 (28.2%). Predominant molecules were bisoprolol (148/327; 45.3% of beta-blocker users), metoprolol prolonged release (91/327; 27.8%), perindopril arginine (103/240; 42.9%), ramipril (93/240; 38.8%), and amlodipine (117/155; 75.5%). Among patients with available dose data, high dose intensity was observed in 31/317 (9.8%) beta-blockers, 61/224 (27.2%) angiotensin-converting enzyme inhibitors, 36/83 (43.4%) angiotensin receptor blockers and 59/134 (44.0%) calcium channel blockers. Patients with uncontrolled blood pressure received fewer antihypertensive classes (2.33 ± 1.32 vs. 2.64 ± 1.30; p=0.022) and less often diuretics (32.9% vs. 46.7%; p=0.008). Conclusions: In elective percutaneous coronary intervention patients, uncontrolled admission blood pressure and apparent treatment resistant hypertension were common. Optimisation of regimen composition and dose intensity may improve blood pressure control in this very-high-risk population.
Lábr et al. (2026) conducted a cohort in chronic coronary syndrome undergoing elective percutaneous coronary intervention (n=433). Uncontrolled blood pressure vs. Controlled blood pressure was evaluated on Use of diuretics (p=0.008). Uncontrolled admission blood pressure was present in 33.7% of elective PCI patients, who received fewer antihypertensive classes and less often diuretics (32.9% vs. 46.7%; p=0.008).
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