Blood Pressure at 6 Months After Acute Myocardial Infarction and Outcomes at 2 Years: The Perils Associated With Excessively Low Blood Pressures |
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| Institution: | 1. Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea;2. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea;3. Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea;4. Division of Bacterial Respiratory Infections, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongwon-gun, Republic of Korea;5. Project Team, Dongwha Pharm Co. Ltd, Seoul, Republic of Korea;6. Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;1. Cardiology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Spain;2. Subdirecció de Planificació Sanitària, Dirección General de Planificació i Recerca en Salut, Health Department, Autonomous Government of Catalonia, Barcelona, Spain;3. HELIS Partners Consulting, Prague, Czech Republic;4. Stent for Life Initiative, Czech Republic;5. STEMI Code Registry Office, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain;6. Master Plan of Cardiovascular Diseases, Health Department, Autonomous Government of Catalonia, Barcelona, Spain;1. Departments of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea;2. Biochemistry and Cell Biology, Kyungpook National University School of Medicine, Daegu, South Korea;3. Cell and Matrix Research Institute, Kyungpook National University School of Medicine, Daegu, South Korea;4. Preventive Medicine, Kyungpook National University School of Medicine, Daegu, South Korea;5. Thoracic Surgery, Kyungpook National University School of Medicine, Daegu, South Korea;6. Center for Lung Cancer, National Cancer Center, Goyang, South Korea;7. Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Chonnam, South Korea;8. Department of Thoracic and Cardiovascular Surgery, Seoul National University School of Medicine, Seoul, South Korea;9. Department of Internal Medicine, Catholic University of Daegu, School of Medicine, Daegu, South Korea;10. Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea;1. Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;2. Translational and Stem Cell Research Laboratory on Stroke, Samsung Medical Center, Republic of Korea |
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| Abstract: | BackgroundThis study aimed to determine the association between achieved blood pressure at 6-month follow-up and cardiovascular outcomes at 2 years in patients treated with β-blockers and renin-angiotensin-aldosterone blockers after acute myocardial infarction (AMI).MethodsWe analyzed data from 5503 patients enrolled in the national AMI registry. Patients with myocardial reinfarction (MrI), rehospitalization for heart failure (rHHF), or stroke before 6-month follow-up were excluded. Achieved blood pressures were categorized into 10-mm Hg increments. The primary outcome was all-cause death. The secondary outcome was a composite of all-cause death, MrI, and rHHF. Hazard ratios (HRs) were estimated with multivariable-adjusted Cox hazards models using 125- to 134-mm Hg systolic blood pressure (SBP) and 75- to 84-mm Hg diastolic blood pressure (DBP) subgroups as reference.ResultsAfter a median follow-up of 2.1 years, SBP < 115 mm Hg was associated with increased risks for all-cause death (adjusted HR: 2.202 1.158-4.188]) and for a composite outcome (HR: 1.682 1.075-2.630]). Likewise, DBP < 75 mm Hg tended to be associated with an increase in all-cause death (HR: 2.078 0.998-4.327] for DBP of 65 to 74 mm Hg; HR: 2.610 1.256-5.423] for DBP < 65 mm Hg). Even in patients <75 years, the risk of a composite outcome was increased for DBP < 65 mm Hg (HR: 2.492 1.401-4.434]).ConclusionsLow blood pressure achieved with β-blocker and renin-angiotensin-aldosterone blocker at 6 months was associated with an increased risk of all-cause mortality independently of confounding factors in patients with AMI. This finding suggests that caution should be taken for patients with AMI who use blood-pressure–lowering treatments. |
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