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Antecedent hypertension confers increased risk for adverse outcomes after initial myocardial infarction
A W Haider1, L Chen, M G Larson
1National Heart, Lung, and Blood Institute's Framingham Heart Study, Mass 01701, USA.
Insights
Hypertension before myocardial infarction (MI) increases the risk of adverse outcomes, including reinfarction and mortality. Effective blood pressure control is crucial for both preventing initial MI and improving prognosis after MI.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Outcomes
Background:
- Previous research focused on blood pressure post-myocardial infarction (MI).
- Limited data exists on the prognostic impact of pre-MI blood pressure.
- Antecedent hypertension's role in post-MI outcomes requires further investigation.
Purpose of the Study:
- To examine the relationship between pre-infarction blood pressure and adverse outcomes following an initial MI.
- To assess the risk associated with antecedent hypertension in patients who have experienced a myocardial infarction.
Main Methods:
- Analysis of 404 subjects from the Framingham Heart Study who experienced an initial MI between 1967 and 1990.
- Classification of subjects based on pre-infarction blood pressure: normotensive, stage I untreated hypertension, and stage II-IV or treated hypertension.
- Use of Cox models to adjust for covariates including age, sex, smoking, glucose intolerance, cholesterol, and prior cardiovascular disease.
Main Results:
- Antecedent hypertension was significantly associated with increased risk of adverse outcomes post-MI.
- Stage II-IV hypertensives had a 2.20-fold increased risk of reinfarction compared to normotensive individuals.
- Stage II-IV hypertensives also faced a 1.45-fold increased risk of all-cause mortality post-MI.
Conclusions:
- Pre-infarction hypertension is a significant predictor of adverse outcomes, including reinfarction and mortality, after myocardial infarction.
- These findings support the importance of blood pressure control in both primary and secondary prevention of cardiovascular events.
- Effective blood pressure management may reduce initial MI risk and improve survival following an MI.
Abstract:
Several studies have examined the association of blood pressure (BP) after myocardial infarction (MI) with a risk for adverse outcome; however, few studies have investigated prognosis after MI as a function of BP before MI. Our goal was to examine the relation of antecedent hypertension to risk of adverse outcomes after initial MI. From 1967 to 1990, 404 subjects followed at the Framingham Heart Study developed an initial MI. These subjects were classified on the basis of preinfarction BP into normotensive (BP<140/90 mm Hg and not receiving antihypertensive treatment; n=118), stage I-untreated hypertension (BP 140 to 159/90 to 99 mm Hg; n=89), and stage II to IV or treated hypertension (BP > or =160/100 mm Hg or treated hypertension; n=197). Cox models were used to adjust for age, sex, smoking, glucose intolerance, total cholesterol, and prior cardiovascular disease. Antecedent hypertension was related to risk of adverse outcome after MI. Compared with normotensive individuals, stage II to IV hypertensives were at increased risk for reinfarction (hazard ratio [HR], 2.20; 95% confidence interval [CI], 1.20 to 4.04). A similar but nonsignificant association was seen in stage I hypertensives (HR, 1.91; 95% CI, 0.97 to 3.77). Stage II to IV hypertensives were at increased risk for all-cause mortality compared with normotensive persons (HR, 1.45; 95% CI, 1.07 to 1.98). Thus, even after MI, a history of antecedent hypertension remains predictive of adverse outcome. These findings are consistent with beneficial effects of BP control in primary and secondary prevention settings. Effective BP control may both reduce the risk for an initial MI and improve outcome in the event that an MI occurs.