Admission Blood Pressure and 1-Year Mortality in Acute MI
Admission Blood Pressure and 1-Year Mortality in Acute MI
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.
Ischemic heart disease is regarded as the leading cause of death world-wide, accounting for 7.1 million fatalities and 84.27 million disability-adjusted life years. Arterial hypertension is a widely known risk factor for cardiovascular diseases, and is part of well-established risk-scoring systems for angina pectoris (AP). Low systolic blood pressure, on the other hand, is associated with inferior outcome of chronic heart failure. It has been proposed that there might be a similar correlation with mortality after ST-segment elevation myocardial infarction (STEMI) and unstable AP. In coronary heart disease, low diastolic blood pressure is associated with an increased incidence of myocardial infarction (MI), as well as higher mortality risk. Data from the Framingham study suggests the influence of systolic and diastolic blood pressure might be age-dependent, with vessel elasticity playing a pivotal role. According to these considerations, pulse pressure, defined as the difference between systolic and diastolic pressure, has been proposed as an independent predictor for both cardiovascular and total mortality, as well as for re-infarction.
Given these findings in patients suffering acute myocardial infarction (AMI) we aimed at assessing to which extent admission blood pressure (systolic, diastolic, and pulse pressure) at the Emergency Department is associated with 1-year mortality in patients with acute myocardial infarction.
Abstract and Introduction
Abstract
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.
Introduction
Ischemic heart disease is regarded as the leading cause of death world-wide, accounting for 7.1 million fatalities and 84.27 million disability-adjusted life years. Arterial hypertension is a widely known risk factor for cardiovascular diseases, and is part of well-established risk-scoring systems for angina pectoris (AP). Low systolic blood pressure, on the other hand, is associated with inferior outcome of chronic heart failure. It has been proposed that there might be a similar correlation with mortality after ST-segment elevation myocardial infarction (STEMI) and unstable AP. In coronary heart disease, low diastolic blood pressure is associated with an increased incidence of myocardial infarction (MI), as well as higher mortality risk. Data from the Framingham study suggests the influence of systolic and diastolic blood pressure might be age-dependent, with vessel elasticity playing a pivotal role. According to these considerations, pulse pressure, defined as the difference between systolic and diastolic pressure, has been proposed as an independent predictor for both cardiovascular and total mortality, as well as for re-infarction.
Given these findings in patients suffering acute myocardial infarction (AMI) we aimed at assessing to which extent admission blood pressure (systolic, diastolic, and pulse pressure) at the Emergency Department is associated with 1-year mortality in patients with acute myocardial infarction.
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