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Admission blood pressure and 1-year mortality in acute myocardial infarction
D Roth1, R Van Tulder1, B Heidinger1
1Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
Insights
In patients with acute myocardial infarction, lower admission blood pressure is linked to higher long-term mortality. Higher blood pressure on admission indicates a reduced risk of death within one year.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Arterial hypertension is a known cardiovascular disease risk factor.
- Low admission blood pressure has been suggested as a mortality predictor.
- The prognostic value of admission blood pressure in acute myocardial infarction (AMI) requires further investigation.
Purpose of the Study:
- To investigate the hypothesis that admission blood pressure in patients with AMI predicts long-term mortality.
- To determine the relationship between admission blood pressure and 1-year mortality in AMI patients.
Main Methods:
- A cohort study included 3943 patients treated for AMI between 1991 and 2009.
- Admission systolic, diastolic, and pulse pressures were analyzed as predictors of 1-year mortality.
- Multivariable regression models adjusted for baseline factors and tested for interactions.
Main Results:
- A cohort of 3943 patients was analyzed, with 3604 surviving after 1 year.
- Increasing admission blood pressure was incrementally associated with decreased 1-year mortality risk.
- The highest blood pressure categories showed a 70% reduced relative risk of mortality compared to the lowest categories, independent of interventions.
Conclusions:
- Admission blood pressure is an inverse predictor of long-term mortality in patients with AMI.
- Lower admission blood pressure in AMI patients should be considered a warning sign.
- The interpretation of admission blood pressure in AMI should differ from standard preventive viewpoints.
Aims:
Arterial hypertension is a well-established factor for increased risk of cardiovascular diseases, but low admission blood pressure has also been suggested as predictor for increased mortality. We hypothesised that in patients with acute myocardial infarction admission blood pressure at the Emergency Department predicts long-term mortality.
Methods:
We included consecutive patients treated for acute myocardial infarction (AMI) at our 2,200-bed tertiary care hospital from 1991 to 2009 into our cohort. Systolic, diastolic and pulse pressure on admission were analysed as main predictors for 1-year mortality. We adjusted for several baseline factors and tested for interactions using multivariable regression models.
Results:
We included 3943 patients among whom 3604 were alive after 1 year. With increasing admission blood pressure 1-year mortality risk decreased incrementally to a 70% reduced relative risk in the highest blood pressure categories vs. the lowest categories. This effect was independent of blood pressure modifying interventions.
Conclusions:
In acute myocardial infarction, admission blood pressure predicts long-term mortality in an inverse relation. With increasing admission blood pressure long-term mortality decreases. Low admission blood pressure should serve as a warning sign in patients with AMI. Admission blood pressure should therefore be interpreted in opposite to the regular, preventive, point of view.
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