Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes

Abstract

Hypertension is well established as a risk factor for the development of atherosclerosis. Data on the impact of hypertension in patients with ST elevation myocardial infarction are so far inconsistent, and are mainly related to studies performed in the thrombolytic era. We assessed the impact of hypertension over the short and long term in 560 patients with ST elevation myocardial infarction (STEMI) and without previously known diabetes, all of whom were submitted to mechanical revascularization and consecutively admitted to our Intensive Cardiac Care Unit. Hypertensive patients were older (p \ 0.001), more frequently male (0.005), and they showed a reduced eGFR (p \ 0.001).Smoking was more frequent in nonhypertensive patients (p \ 0.001), while the incidence of three-vessel coronary artery disease was higher in hypertensive patients (p = 0.003). No difference in the in-hospital mortality rates for the two subgroups was detected. At follow-up (median 32.5 months, 25th-75th percentile 16.9-47.3 months), Kaplan-Meier survival analysis detected no differences in mortality between hypertensive and nonhypertensive patients (log rank v 2 0.38, p = 0.538). According to our data, obtained from a large series of consecutive STEMI patients without previously known diabetes, all of whom were submitted to primary PCI, a history of hypertension does not affect mortality over either the short or the long term. Moreover, hypertensive patients showed an altered glucose response to stress, as indicated by higher admission glucose values, poorer in-hospital glucose control, and a higher incidence of acute insulin resistance (as indicated by the HOMA index). Hypertensive patients therefore appear to warrant careful metabolic management during their hospital courses.

Impact of hypertension on infarct size in ST elevation myocardial infarction patients undergoing primary angioplasty

“…In a recent study, Lazzeri et al [20] in a population of 560 STEMI patients without known diabetes, showed at a median follow-up of 32 months no impact of hypertension on mortality. This is the first study investigating the impact of hypertension on infarct size as evaluated by scintigraphic technique.…”

“…In a study by Majahalme et al [14], in-hospital and 6-month mortality in hypertensive and normotensive acute coronary syndrome (ACS) patients were similar, whereas the rate of recurrent angina, paroxysmal atrial fibrillation, and acute renal failure was higher among patients with hypertension. While the negative prognostic impact of hypertension after thrombolysis in patients STEMI, has been clearly demonstrated, and mainly due to higher rates of heart failure, stroke, cranial hemorrhage, and mortality [10][11][12][13][14][15][16], only a few studies [17][18][19][20] have assessed the impact of hypertension on outcome after primary angioplasty, which currently represents the best reperfusion strategy.…”

“…However, data on the prognostic impact of hypertension in patients with STEMI are so far inconsistent, mainly related to studies performed in the thrombolytic era [11][12][13][14][15]. In fact, although elevated levels of heart failure, stroke, cranial hemorrhage, and mortality risk have been shown in patients with antecedent hypertension receiving thrombolytic therapy [10][11][12][13][14][15][16], still controversial is the prognostic role of hypertension in terms of survival after primary angioplasty [17][18][19][20]. In particular, few data focused on the impact of hypertension on infarct size.…”

Clinical characteristics and short-term outcomes in patients with elevated admission systolic blood pressure after acute ST-elevation myocardial infarction: a population-based study

“…Parodi et al 35 found the 5-year mortality in patients with and without hypertension was comparable; however, patients with hypertension were at a higher risk of developing heart failure after STEMI. Lazzeri et al 36 assessed the influence of hypertension on the short-term and long-term outcome in 560 patients with STEMI submitted to mechanical revascularisation and found that a history of hypertension had no affect on either short-term or long-term mortality. Similar results were also found in Cecchi et al 's report 37.…”

Impact of diabetes and hypertension on cardiovascular outcomes in patients with coronary artery disease receiving percutaneous coronary intervention

“…Hypertension did not affect short-and long term mortality in patients with ST elevation myocardial infarction (STEMI) receiving PCI [2, 3]. However, hypertension was the only independent long-term predictor of mortality in patients with unstable angina (US) receiving coronary stenting [4].…”