Impact of Controlled Blood Pressure and Pulse Rate at Discharge on Clinical Outcomes in Patients with Non-ST-segment
Yuya Watanabe1, Kenichi Sakakura1, Hiroyuki Jinnouchi1
1Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan.
Insights
Achieving good control of systolic blood pressure (SBP) and pulse rate (PR) at discharge in non-ST-segment elevation myocardial infarction (NSTEMI) patients treated with ACE inhibitors/ARBs and beta-blockers is linked to fewer major cardiovascular events.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), and beta-blockers (BBs) are standard treatments for non-ST-segment elevation myocardial infarction (NSTEMI).
- Optimal blood pressure and pulse rate targets at discharge for these patients remain undefined.
Purpose of the Study:
- To investigate the association between systolic blood pressure (SBP) and pulse rate (PR) control at discharge and clinical outcomes in NSTEMI patients receiving ACEis/ARBs and BBs.
Main Methods:
- Retrospective analysis of 596 NSTEMI patients treated with ACEis/ARBs and BBs.
- Patients were classified into good control (SBP ≤130 mmHg, PR ≤80 bpm) and poor control (SBP >130 mmHg or PR >80 bpm) groups.
- Primary endpoint was major adverse cardiovascular events (MACEs), including death, non-fatal MI, and heart failure readmission.
Main Results:
- Over a median follow-up of 1,267 days, 205 MACEs occurred.
- The poor control group exhibited significantly higher MACE rates compared to the good control group (p=0.003).
- Good control was independently associated with a reduced risk of MACEs (HR 0.748, p=0.048).
Conclusions:
- Effective control of SBP and PR at discharge is associated with improved long-term outcomes in NSTEMI patients on ACEis/ARBs and BBs.
- Optimizing medication titration at discharge is crucial for mitigating adverse cardiovascular events.
Abstract:
Objective Angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), and beta-blockers (BBs) are commonly prescribed for patients with non-ST-segment elevation myocardial infarction (NSTEMI). However, the target blood systolic pressure (SBP) or pulse rate (PR) in these patients has not been established. This study aimed to assess the association between SBP/PR control at discharge and the clinical outcomes in patients with NSTEMI. Methods We retrospectively analyzed 596 patients with NSTEMI who received both ACEis/ARBs and BBs at discharge. Patients were categorized into a good control group (SBP ≤130 mmHg and PR ≤80 bpm, n=379) and poor control group (SBP >130 mmHg or PR >80 bpm, n=217). The primary endpoint was major cardiovascular events (MACEs), defined as the composite of all-cause death, non-fatal myocardial infarction, and heart failure readmission. Results During a median follow-up of 1,267 days, 205 MACEs occurred. Kaplan-Meier curves showed higher MACE rates in the poor control group than in the good control group (p=0.003). A multivariate Cox hazard analysis revealed that the good control group was inversely associated with MACEs (hazard ratio 0.748, 95% confidence interval: 0.561-0.997, p=0.048) after controlling for confounding factors. Conclusion Good control of SBP and PR was inversely associated with long-term adverse events in patients with NSTEMI who received both ACEis/ARBs and BBs. This study highlights the significance of optimizing medication titrations at discharge.
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