Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction

Abstract

Abstract-The influence of blood pressure on outcomes after high-risk myocardial infarction is not well characterized. We studied the relationship between blood pressure and the risk of cardiovascular events in 14 703 patients with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction in the Valsartan in Myocardial Infarction Trial. We assessed the relationship between antecedent hypertension and outcomes and the association between elevated (systolic: Ͼ140 mm Hg) or low blood pressure (systolic: Ͻ100 mm Hg) in 2 of 3 follow-up visits during the first 6 months and subsequent cardiovascular events over a median 24.

Antecedent Hypertension and Myocardial Injury in Patients With Reperfused St-Elevation Myocardial Infarction

“…These results fit well with recent prospective STEMI registry studies which reported a prevalence between 60 and 70 % [23,24]. Antecedent HTN has been acknowledged as significant risk factor for adverse outcome in survivors of acute MI for many years [4][5][6]. For instance, Thune et al found that antecedent HTN at the time of MI was strongly associated with an increased risk of future heart failure, stroke, cardiovascular death and a composite endpoint consisting of death, myocardial infarction, heart failure, stroke, or cardiac arrest in more than 14.000 patients included in the VALI-ANT trial (Valsartan in Myocardial Infarction Trial) [4].…”

“…The median time between the index event and CMR scan was 3 [2][3][4] days. CMR findings and their relation with antecedent HTN are shown in Table 4.…”

“…Antecedent HTN has been acknowledged as significant risk factor for adverse outcome in survivors of acute MI for many years [4][5][6]. For instance, Thune et al found that antecedent HTN at the time of MI was strongly associated with an increased risk of future heart failure, stroke, cardiovascular death and a composite endpoint consisting of death, myocardial infarction, heart failure, stroke, or cardiac arrest in more than 14.000 patients included in the VALI-ANT trial (Valsartan in Myocardial Infarction Trial) [4]. Nevertheless, over the last years, reperfusion strategies and pharmacological interventions were significantly refined and consequently improved the outcome of patients presenting with acute MI [25].…”

“…Accordingly, patients with myocardial infarction (MI) and a history of HTN are known to be older and to have a higher rate of comorbidities and more extensive atherosclerotic disease than patients with MI but no HTN [4]. Several studies demonstrated that patients with MI and antecedent HTN are at increased risk for adverse cardiovascular events, such as heart failure, recurrent MI or death [4][5][6][7][8][9][10][11]. However, whether differences in myocardial salvage, infarct size or microvascular injury contribute to the adverse outcome in contemporary reperfused MI patients is unknown.…”

Curva J. Controversias

“…Se habla de causalidad reversa cuando la enfermedad (como infarto de miocardio) reduce el factor de riesgo primario (en este caso, la presión diastólica o sistóli-ca). Lo cual muestra una relación entre disfunción cardiaca y curva J sistólica o diastólica, como se puede observar en el estudio VALUE (8) , en donde luego de un infarto de miocardio, aquellos pacientes con una PS sostenida <100 mmHg en los siguientes meses de control (mes 1, 3 y 6) tuvieron peores eventos cardiovasculares, lo cual a su vez fue más frecuente en aquellos con mayor incidencia de ondas Q. Es por esta razón que, diversos estudios que han evaluado el impacto de la presencia de la curva J no consideran aquellos que han incluido a pacientes con infarto de miocardio. Otras enfermedades que se vinculan con una disminución de la presión sanguínea incluyen a neoplasias y malnutrición.…”