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Eur J Heart Fail. 2018 Feb;20(2):323-331. doi: 10.1002/ejhf.1131. Epub 2018 Jan 4.

Association between mean systolic and diastolic blood pressure throughout the follow-up and cardiovascular events in acute myocardial infarction patients with systolic dysfunction and/or heart failure: an analysis from the High-Risk Myocardial Infarction Database Initiative.

Author information

1
INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France.
2
Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
3
Université de Lorraine, Institut Elie Cartan de Lorraine, UMR 7502, Vandoeuvre-lès-Nancy, France.
4
CNRS, Institut Elie Cartan de Lorraine, UMR 7502, Vandoeuvre-lès-Nancy, France.
5
Team BIGS, INRIA, Villers-lès-Nancy, France.
6
Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
7
BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK.
8
Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.
9
Department of Cardiology, University of Bergan, Stavanger University Hospital, Stavanger, Norway.

Abstract

BACKGROUND:

Observational data have described the association of blood pressure (BP) with mortality as 'J-shaped', meaning that mortality rates increase below a certain BP threshold. We aimed to analyse the associations between BP and prognosis in a population of acute myocardial infarction (MI) patients with heart failure (HF) and/or systolic dysfunction.

METHODS AND RESULTS:

The datasets included in this pooling initiative are derived from four trials: CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT. A total of 28 771 patients were included in this analysis. Arithmetic means of all office BP values measured throughout follow-up were used. The primary outcome was cardiovascular death. The mean age was 65 ± 11.5 years and 30% were female. Patients in the lower systolic BP (SBP) quintiles had higher rates of cardiovascular death (reference: SBP 121-128 mmHg) [adjusted hazard ratio (HR) 2.49, 95% confidence interval (CI) 2.26-2.74 for SBP ≤112 mmHg, and HR 1.29, 95% CI 1.16-1.43 for SBP 113-120 mmHg]. The findings for HF hospitalization and MI were similar. However, stroke rates were higher in patients within the highest SBP quintile (reference: SBP 121-128 mmHg) (HR 1.38, 95% CI 1.11-1.72). Patients who died had a much shorter follow-up (0.7 vs. 2.1 years), less BP measurements (4.6 vs. 9.8) and lower mean BP (-8 mmHg in the last SBP measurement compared with patients who remained alive during the follow-up), suggesting that the associations of low BP and increased cardiovascular death represent a reverse causality phenomenon.

CONCLUSION:

Systolic BP values <125 mmHg were associated with increased cardiovascular death, but these findings likely represent a reverse causality phenomenon.

KEYWORDS:

Blood pressure; Cardiovascular outcomes; Heart failure; Myocardial infarction

PMID:
29314455
DOI:
10.1002/ejhf.1131
[Indexed for MEDLINE]
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