J Korean Med Sci.  2009 Oct;24(5):800-806. 10.3346/jkms.2009.24.5.800.

Clinical Effects of Hypertension on the Mortality of Patients with Acute Myocardial Infarction

• Kang DG
• Jeong MH
• Ahn Y
• Chae SC
• Hur SH
• Hong TJ
• Kim YJ
• Seong IW
• Chae JK
• Rhew JY
• Chae IH
• Cho MC
• Bae JH
• Rha SW
• Kim CJ
• Jang YS
• Yoon J
• Seung KB
• Park SJ
• Korea Acute Myocardial Infarction Registry Investigators

• KMID: 1781997
• DOI: http://doi.org/10.3346/jkms.2009.24.5.800

Abstract

The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class > or =III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade < or =2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.

Keyword

Hypertension; Myocardial infarction; Mortality

MeSH Terms

Acute Disease
Age Factors
Aged
Cerebrovascular Disorders/etiology
Diabetes Mellitus/etiology
Female
Heart Failure/etiology
Hospital Mortality
Humans
Hyperlipidemias/etiology
Hypertension/*complications
Male
Middle Aged
Myocardial Infarction/complications/*mortality/therapy
Peripheral Vascular Diseases/etiology
Predictive Value of Tests
Registries
Sex Factors

Reference

1. Lewis EF, Moye LA, Rouleau JL, Sacks FM, Arnold JM, Warnica JW, Flaker GC, Braunwald E, Pfeffer MA. CARE Study. Predictors of late development of heart failure in stable survivors of myocardial infarction: the CARE study. J Am Coll Cardiol. 2003. 42:1446–1453.

2. Richards AM, Nicholls MG, Troughton RW, Lainchbury JG, Elliott J, Frampton C, Espiner EA, Crozier IG, Yandle TG, Turner J. Antecedent hypertension and heart failure after myocardial infarction. J Am Coll Cardiol. 2002. 39:1182–1188.

3. Witt BJ, Ballman KV, Brown RD Jr, Meverden RA, Jacobsen SJ, Roger VL. The incidence of stroke after myocardial infarction: a meta-analysis. Am J Med. 2006. 119:354.e1–354.e9.

4. Miura K, Daviglus ML, Dyer AR, Liu K, Garside DB, Stamler J, Greenland P. Relationship of blood pressure to 25-year mortality due to coronary heart disease, cardiovascular diseases, and all causes in young adult men: The Chicago Heart Association Detection Project in Industry. Arch Intern Med. 2001. 161:1501–1508.

5. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002. 360:1903–1913.

6. Willich SN, Müller-Nordhorn J, Kulig M, Binting S, Gohlke H, Hahmann H, Bestehorn K, Krobot K, Völler H. PIN Study Group. Cardiac risk factors, medication, and recurrent clinical events after acute coronary disease; a prospective cohort study. Eur Heart J. 2001. 22:307–313.

7. Piegas LS, Avezum A, Pereira JC, Neto JM, Hoepfner C, Farran JA, Ramos RF, Timerman A, Esteves JP. AFIRMAR Study Investigators. Risk factors for myocardial infarction in Brazil. Am Heart J. 2003. 146:331–338.

8. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, Mc-Queen M, Budaj A, Pais P, Varigos J, Lisheng L. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004. 364:937–952.

9. Richards AM, Nicholls MG, Troughton RW, Lainchbury JG, Elliott J, Frampton C, Espiner EA, Crozier IG, Yandle TG, Turner J. Antecedent hypertension and heart failure after myocardial infarction. J Am Coll Cardiol. 2002. 39:1182–1188.

10. Thune JJ, Signorovitch J, Kober L, Velazquez EJ, McMurray JJ, Califf RM, Maggioni AP, Rouleau JL, Howlett J, Zelenkofske S, Pfeffer MA, Solomon SD. Effect of antecedent hypertension and follow-up blood pressure on outcomes after high-risk myocardial infarction. Hypertension. 2008. 51:48–54.

11. Rakugi H, Yu H, Kamitani A, Nakamura Y, Ohishi M, Kamide K, Nakata Y, Takami S, Higaki J, Ogihara T. Links between hypertension and myocardial infarction. Am Heart J. 1996. 132:213–221.

12. Korea Acute Myocardial Infarction Registry (KAMIR) Investigators. Lee KH, Jeong MH, Ahn YK, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi D, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Cho JG, Park SJ. Other Korea Acute Myocardial Infarction Registry Investigators. Gender differences of success rate of percutaneous coronary intervention and short term cardiac events in Korea Acute Myocardial Infarction Registry. Int J Cardiol. 2008. 130:227–234.

13. Lee SR, Jeong MH, Ahn YK, Chae SC, Hur SH, Kim YJ, Seong IW, Chae JK, Hong TJ, Rhew JY, Cho MC, Bae JH, Rha SW, Kim CJ, Jang YS, Park SJ. Korea Acute Myocardial Infarction Registry Investigators. Clinical safety of drug-eluting stents in the Korea acute myocardial infarction registry. Circ J. 2008. 72:392–398.

14. Pastor-Barriuso R, Banegas JR, Damian J, Appel LJ. Systolic blood pressure, diastolic blood pressure, and pulse pressure: an evaluation of their joint effect on mortality. Ann Intern Med. 2003. 139:731–739.

15. Sipahi I, Tuzcu EM, Schoenhagen P, Wolski KE, Nicholls SJ, Balog C, Crowe TD, Nissen SE. Effects of normal, pre-hypertensive, and hypertensive blood pressure levels on progression of coronary atherosclerosis. J Am Coll Cardiol. 2006. 48:833–838.

16. Kenchaiah S, Davis BR, Braunwald E, Rouleau JL, Dagenais GR, Sussex B, Steingart RM, Brown EJ Jr, Lamas GA, Gordon D, Bernstein V, Pfeffer MA. Survival and Ventricular Enlargement Trial. Antecedent hypertension and the effect of captopril on the risk of adverse cardiovascular outcomes after acute myocardial infarction with left ventricular systolic dysfunction: Insights from the Survival and Ventricular Enlargement Trial. Am Heart J. 2004. 148:356–364.

17. Kuulasmaa K, Tunstall-Pedoe H, Dobson A, Fortmann S, Sans S, Tolonen H, Evans A, Ferrario M, Tuomilehto J. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet. 2000. 355:675–687.

18. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH, Capewell S. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007. 356:2388–2398.

19. Khor GL. Cardiovascular epidemiology in the Asia-Pacific region. Asia Pac J Clin Nutr. 2001. 10:76–80.

20. Ko M, Kim MT, Nam JJ. Assessing risk factors of coronary heart disease and its risk prediction among Korean adults: the 2001 Korea National Health and Nutrition Examination Survey. Int J Cardiol. 2006. 110:184–190.

21. Majahalme SK, Smith DE, Cooper JV, Kline-Rogers E, Mehta RH, Eagle KA, Bisognano JD. Comparison of patients with acute coronary syndrome with and without systemic hypertension. Am J Cardiol. 2003. 92:258–263.

22. Mehta RH, Roe MT, Chen AY, Lytle BL, Pollack CV Jr, Brindis RG, Smith SC Jr, Harrington RA, Fintel D, Fraulo ES, Califf RM, Gibler WB, Ohman EM, Peterson ED. Recent trends in the care of patients with non-ST-segment elevation acute coronary syndromes: insights from the CRUSADE initiative. Arch Intern Med. 2006. 166:2027–2034.

23. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intra venous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003. 361:13–20.

24. Song YB, Hahn JY, Gwon HC, Kim JH, Lee SH, Jeong MH. KAMIR investigators. The impact of initial treatment delay using primary angioplasty on mortality among patients with acute myocardial infarction: from the Korea Acute Myocardial Infarction Registry. J Korean Med Sci. 2008. 23:357–364.

25. Mauri F, Maggioni AP, Franzosi MG, de Vita C, Santoro E, Santoro L, Giannuzzi P, Tognoni G. A simple electrocardiographic predictor of the outcome of patients with acute myocardial infarction treated with a thrombolytic agent. A Gruppo Italiano per lo Studio della Sopravvivenza nell' Infarto Miocardico (GISSI-2)-Derived Analysis. J Am Coll Cardiol. 1994. 24:600–607.

26. Devereux RB, Roman MJ. Inter-relationships between hypertension, left ventricular hypertrophy and coronary heart disease. J Hypertens. 1993. 11:Suppl. S3–S9.

27. Herlitz J, Bång A, Karlson BW. Five-year prognosis after acute myocardial infarction in relation to a history of hypertension. Am J Hypertens. 1996. 9:70–76.

28. Yagi M, Nakao K, Honda T, Tsurumi Y, Kasanuki H. Clinical characteristics and early outcomes of very elderly patients in the reperfusion era. Int J Cardiol. 2004. 94:41–46.

29. White HD, Aylward PE, Huang Z, Dalby AJ, Weaver WD, Barvik S, Marin-Neto JA, Murin J, Nordlander RO, van Gilst WH, Zannad F, McMurray JJ, Califf RM, Pfeffer MA. VALIANT Investigators. Mortality and morbidity remain high despite captopril and/or Valsartan therapy in elderly patients with left ventricular systolic dysfunction, heart failure, or both after acute myocardial infarction: results from the Valsartan in Acute Myocardial Infarction Trial (VALIANT). Circulation. 2005. 112:3391–3399.