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Antecedent hypertension and heart failure after myocardial infarction
A Mark Richards1, M Gary Nicholls, Richard W Troughton
1Cardiology, Christchurch Hospital, Christchurch, New Zealand. barbara.griffin@chmeds.ac.nz
Insights
Hypertension before myocardial infarction (MI) increases heart failure (HF) risk by worsening neurohormonal activation and ventricular remodeling. This interaction, especially in older patients, significantly elevates mortality post-MI.
Area of Science:
- Cardiology
- Clinical Medicine
- Hypertension Research
Background:
- Hypertension is linked to increased mortality after myocardial infarction (MI).
- Neurohormonal activation and adverse ventricular remodeling are expected in hypertensive patients post-MI.
- Limited data exists on serial changes in neurohormones, ventricular imaging, and outcomes in hypertensive vs. normotensive patients post-MI.
Purpose of the Study:
- To assess the relationship between antecedent hypertension and neurohormones, ventricular remodeling, and clinical heart failure (HF) after myocardial infarction (MI).
Main Methods:
- 1,093 patients with acute MI were studied (436 hypertensive, 657 normotensive).
- Serial neurohormonal sampling and radionuclide ventriculography were performed in 68% of patients at 1-4 days and 3-5 months post-MI.
- Clinical outcomes were recorded over a mean follow-up of two years.
Main Results:
- Hypertensive patients exhibited higher plasma neurohormones and increased left ventricular volumes compared to normotensive patients post-MI.
- Left ventricular ejection fraction improved in normotensive but not hypertensive patients.
- Hypertensive patients had higher inpatient and post-discharge mortality, and increased rates of inpatient and late heart failure requiring readmission.
Conclusions:
- Antecedent hypertension, in conjunction with age, neurohumoral activation, and early ventricular remodeling, significantly increases the risk of heart failure after myocardial infarction.
Objectives:
We sought to assess the relationship of antecedent hypertension to neurohormones, ventricular remodeling and clinical heart failure (HF) after myocardial infarction (MI).
Background:
Heart failure is a probable contributor to the increased mortality observed after MI in those with antecedent hypertension. Hence, neurohormonal activation, adverse ventricular remodeling and a higher incidence of clinical HF may be expected in this group. However, no previous report has documented serial postinfarction neurohumoral status, serial left ventricular imaging and clinical outcomes over prolonged follow-up in a broad spectrum of patients with and without antecedent hypertension.
Methods:
Inpatient events were documented in 1,093 consecutive patients (436 hypertensive and 657 normotensive) with acute MI. In 68% (282 hypertensive, 465 normotensive) serial neurohormonal sampling and radionuclide ventriculography were performed one to four days and three to five months after infarction. Clinical outcomes were recorded over a mean follow-up of two years.
Results:
Plasma neurohormones were significantly higher in hypertensives than in normotensives one to four days and three to five months after infarction. From similar initial values, left ventricular volumes increased significantly in hypertensives, compared with normotensives. Left ventricular ejection fraction rose significantly in normotensive but not hypertensive patients. Together with higher inpatient (8.1% vs. 4.4%, p < 0.002) and post-discharge mortality (9.5% vs. 5.5%, p = 0.043), hypertensive patients incurred more inpatient HF (33% vs. 24%, p < 0.001) and more late HF requiring readmission to hospital (12.4% vs. 5.5%, p < 0.001). Antecedent hypertension predicted late HF in patients >64 years of age with neurohormonal activation and early left ventricular dilation.
Conclusions:
Antecedent hypertension interacts with age, neurohumoral activation and early ventricular remodeling to confer greater risk of HF after MI.