Association between mean systolic and diastolic blood pressure throughout the follow-up and cardiovascular events in acute myocardial infarction patients with systolic dysfunction and/or heart failure: an analysis from the High-Risk Myocardial Infarction Database Initiative

Ferreira, J. P., Duarte, K., Pfeffer, M. A., McMurray, J. J.V. , Pitt, B., Dickstein, K., Zannad, F. and Rossignol, P. (2018) Association between mean systolic and diastolic blood pressure throughout the follow-up and cardiovascular events in acute myocardial infarction patients with systolic dysfunction and/or heart failure: an analysis from the High-Risk Myocardial Infarction Database Initiative. European Journal of Heart Failure, 20(2), pp. 323-331. (doi: 10.1002/ejhf.1131) (PMID:29314455)

Abstract

Background: Observational data have described the association of blood pressure (BP) with mortality as ‘J-shaped’, meaning that mortality rates increase below a certain BP threshold. We aimed to analyse the associations between BP and prognosis in a population of acute myocardial infarction (MI) patients with heart failure (HF) and/or systolic dysfunction. Methods and results: The datasets included in this pooling initiative are derived from four trials: CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT. A total of 28 771 patients were included in this analysis. Arithmetic means of all office BP values measured throughout follow-up were used. The primary outcome was cardiovascular death. The mean age was 65 ± 11.5 years and 30% were female. Patients in the lower systolic BP (SBP) quintiles had higher rates of cardiovascular death (reference: SBP 121–128 mmHg) [adjusted hazard ratio (HR) 2.49, 95% confidence interval (CI) 2.26–2.74 for SBP ≤112 mmHg, and HR 1.29, 95% CI 1.16–1.43 for SBP 113–120 mmHg]. The findings for HF hospitalization and MI were similar. However, stroke rates were higher in patients within the highest SBP quintile (reference: SBP 121–128 mmHg) (HR 1.38, 95% CI 1.11–1.72). Patients who died had a much shorter follow-up (0.7 vs. 2.1 years), less BP measurements (4.6 vs. 9.8) and lower mean BP (–8 mmHg in the last SBP measurement compared with patients who remained alive during the follow-up), suggesting that the associations of low BP and increased cardiovascular death represent a reverse causality phenomenon. Conclusion: Systolic BP values <125 mmHg were associated with increased cardiovascular death, but these findings likely represent a reverse causality phenomenon.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Ferreira, J. P., Duarte, K., Pfeffer, M. A., McMurray, J. J.V., Pitt, B., Dickstein, K., Zannad, F., and Rossignol, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 04 January 2018
• Copyright Holders: Copyright © 2018 The Authors and European Society of Cardiology
• First Published: First published in European Journal of Heart Failure 20(2):323-331
• Publisher Policy: Reproduced in accordance with the publisher copyright policy