Effect of antecedent hypertension and follow-up blood pressure on outcomes after high-risk myocardial infarction

Thune, J.J. et al. (2008) Effect of antecedent hypertension and follow-up blood pressure on outcomes after high-risk myocardial infarction. Hypertension, 51, pp. 48-54. (doi:10.1161/​HYPERTENSIONAHA.107.093682)

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Abstract

The influence of blood pressure on outcomes after high-risk myocardial infarction is not well characterized. We studied the relationship between blood pressure and the risk of cardiovascular events in 14 703 patients with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction in the Valsartan in Myocardial Infarction Trial. We assessed the relationship between antecedent hypertension and outcomes and the association between elevated (systolic: >140 mm Hg) or low blood pressure (systolic: <100 mm Hg) in 2 of 3 follow-up visits during the first 6 months and subsequent cardiovascular events over a median 24.7 months of follow-up. Antecedent hypertension independently increased the risk of heart failure (hazard ratio [HR]: 1.19; 95% CI: 1.08 to 1.32), stroke (HR: 1.27; 95% CI: 1.02 to 1.58), cardiovascular death (HR: 1.11; 95% CI: 1.01 to 1.22), and the composite of death, myocardial infarction, heart failure, stroke, or cardiac arrest (HR: 1.13; 95% CI: 1.06 to 1.21). While low blood pressure in the postmyocardial infarction period was associated with increased risk of adverse events, patients with elevated blood pressure (n=1226) were at significantly higher risk of stroke (adjusted HR: 1.64; 95% CI: 1.17 to 2.29) and combined cardiovascular events (adjusted HR: 1.14; 95% CI: 1.00 to 1.31). Six months after a high-risk myocardial infarction, elevated systolic blood pressure, a potentially modifiable risk factor, is associated with an increased risk of subsequent stroke and cardiovascular events. Whether aggressive antihypertensive treatment can reduce this risk remains unknown. Key Words: myocardial infarction heart failure, congestive hypertension hypotension mortality Hypertension is an established risk factor for progression of cardiovascular disease,1 and antihypertensive treatment has been associated with reduced risk of myocardial infarction (MI), heart failure (HF), stroke, and cardiovascular death.2,3 While hypertension before MI is associated with greater left ventricular (LV) dilation4,5 and a higher risk of subsequent HF, stroke, and death,6–12 a drop in blood pressure after MI is common.13,14 Thus, the influence of post-MI blood pressure on cardiovascular outcomes may be complex, particularly in patients with large infarctions. To better understand the relationship between blood pressure and risk in the post-MI patient, we performed a posthoc analysis of data from the VALsartan In Acute myocardial INfarction Trial (VALIANT) to assess the effect of antecedent hypertension and post-MI systolic blood pressure on subsequent adverse cardiovascular outcomes.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Thune, J.J., Signorovitch, J., Kober, L., Velazquez, E.J., McMurray, J.J., Califf, R.M., Maggioni, A.P., Rouleau, J.L., Howlett, J., Zelenkofske, S., Pfeffer, M.A., and Solomon, S.D.
College/School:College of Medical Veterinary and Life Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Hypertension
Publisher:American Heart Association
ISSN:0194-911X
ISSN (Online):1524-4563

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