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Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction

David Carrick1,2, Caroline Haig3, Annette M Maznyczka1,2

  • 1From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).

Hypertension (Dallas, Tex. : 1979)
|July 18, 2018
PubMed

Insights

Patients with hypertension experienced worse outcomes after acute myocardial infarction, including reduced left ventricular ejection fraction improvement and increased risk of death or heart failure, linked to severe microvascular injury.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Hypertension Research

Background:

  • Hypertension is a major risk factor for cardiovascular disease.
  • Microvascular injury plays a role in acute myocardial infarction (MI) pathophysiology.
  • The impact of hypertension on microvascular injury post-MI requires further investigation.

Purpose of the Study:

  • To investigate the pathophysiology of microvascular injury in ST-segment-elevation myocardial infarction (STEMI) patients with a history of hypertension.
  • To assess the relationship between antecedent hypertension and microvascular dysfunction, cardiac function, and clinical outcomes post-MI.

Main Methods:

  • A prospective cohort study of 324 STEMI patients undergoing percutaneous coronary intervention.
  • Invasive and noninvasive measures of microvascular injury, cardiac MRI at 2 days and 6 months.
  • Assessment of health outcomes including myocardial hemorrhage, all-cause death, and heart failure over a median 4-year follow-up.

Main Results:

  • Patients with hypertension were older and less likely to be smokers.
  • No significant differences in coronary blood flow, microvascular resistance, infarct pathology, or inflammation were observed between hypertensive and non-hypertensive groups.
  • Hypertensive patients showed less improvement in left ventricular ejection fraction at 6 months (5.3% vs. 7.4%).
  • Antecedent hypertension was associated with increased risk of myocardial hemorrhage and all-cause death or heart failure post-discharge.

Conclusions:

  • Severe progressive microvascular injury is implicated in the pathophysiology and prognosis of hypertensive patients with acute myocardial infarction.
  • Hypertension negatively impacts left ventricular remodeling and long-term outcomes following STEMI.
  • Microvascular dysfunction may be a key mechanism linking hypertension to adverse outcomes in acute myocardial infarction.

Keywords:
atherosclerosishypertensionmyocardial infarctionprognosisreperfusion injury

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