The association between 24-h blood pressure variability and major adverse cardiac events (MACE) in hospitalized patients with acute myocardial infarction: a retrospective cohort study

Abstract

Background Acute myocardial infarction (AMI) is major cardiovascular disease that causes high morbidity and mortality. In AMI, ischemia and necrosis affected some cardiomyocytes leading to a decrease in myocardial contractility which is followed by an acute proinflammation reaction and increased sympathetic tone. Meanwhile, high blood pressure variability (BPV) causing an increased left ventricular workload, heart rate, myocardial oxygen demand and induces proinflamations and endothelial dysfunction. Therefore a high BPV and its associated pathological effects are likely to aggravate the physiological function of the heart and affect the emergence of acute cardiac complications in AMI patients. This study aims to investigate the association’s between short-term BPV and major adverse cardiac events (MACE) in AMI patients. This retrospective cohort study used simple random sampling to identify AMI patients who were hospitalized at Cipto Mangunkusumo National Hospital between January 2018 and December 2019. Mann Withney was performed to investigate the association between BPV and MACE. Results The average systolic BPV value which was calculated as standard deviation (SD) and average real variability (ARV) was higher in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 13.28 ± 5.41 mmHg and 9.88 ± 3.81 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.76 (4.59–26.17) mmHg and 8.65 (3.22–19.35) mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic SD and systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE. Conclusions The BPV of AMI patients who experience MACE was higher than that of non-MACE AMI patients. There was no significant association between BPV ​​and MACE during the acute phase of AMI.

Determining the Association between 24-Hour Blood Pressure Variability and Major Adverse Cardiac Events (MACE) in Hospitalized Patients with Acute Myocardial Infarction: A Prospective Study

“…The mean BPV value found in this study was slightly lower than the value found in the study by Harefa (2021), which looked at the relationship between major adverse cardiac events (MACE) and 24-hour blood pressure variability in hospitalized patients with acute coronary syndrome: A retrospective cohort study [1] -During the seven-day observation period, MACEs occurred in 37 percent and 15 percent of patients, respectively, in the Cesare Cuspidi study [14] and Harefa study [1] [15]. The study indicate that BPV and MACE did not have a significant correlation while the first seven days of patients with ACS.…”

“…The rate of MACE in our study was 17,56%. This result is higher than those of the 2019 Cipto Mangunkusumo National Hospital study [1] and Anastasia et al [13] observations on ACS patients , and saw that as 15,8% and 11.9%, separately had MACE.…”

“…"Blood pressure (BP) variability is a dynamic occurrence including short-, medium-, and long-term fluctuations that are the result of a complex interplay between behavioral, humoral, and neural or reflex influences. The extent of this fluctuation depends on several variables, including blood pressure status (i.e., normotonic versus hypertensive), changes in plasma volume, fluctuations in preload and post-load, respiratory cycle, use of antihypertensive drugs, and individual responses to various Response to everyday stimuli such as physical activity, mental stress, sleep duration/quality, smoking, alcohol consumption, seasonal changes in outdoor temperature, and other physiological and pathological factors" [1]. "Blood pressure variability (BPV) is presently considered a novel risk factor for cardiovascular disease.…”

Relationship between 24 h blood pressure variability and mortality in acute myocardial infarction patients

“…These findings were consistent with the results of the present study, which demonstrated that DBP‐ARV is an important contributing factor to increased mortality risk in patients with AMI. Additionally, a previous retrospective study indicated no significant correlation between 24 h SBP and DBP SD and ARV, and the occurrence of in‐hospital MACEs in patients with AMI 25 . Similarly, the present study showed no significant correlation between the SBP‐ARV and the risk of short‐ and long‐term death in patients with AMI.…”

“…Additionally, a previous retrospective study indicated no significant correlation between 24 h SBP and DBP SD and ARV, and the occurrence of in-hospital MACEs in patients with AMI. 25 Similarly, the present study showed no significant correlation between the SBP-ARV and the risk of short-and long-term death in patients with AMI.…”