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Association between six-month blood pressure level and 1-year heart failure in hypertensive patients with acute myocardial infarction

Session Poster Session 4

Speaker Seung-Jae Joo

Event : Heart Failure 2018

  • Topic : hypertension
  • Sub-topic : Hypertension - Other
  • Session type : Poster Session

Authors : S-J Joo (Jeju,KR), J-G Lee (Jeju,KR), K-Y Boo (Jeju,KR), J-H Choi (Jeju,KR), S-Y Kim (Jeju,KR), K-S Kim (Jeju,KR), M-H Jeong (Gwangju,KR)

Authors:
S-J Joo1 , J-G Lee1 , K-Y Boo1 , J-H Choi1 , S-Y Kim1 , K-S Kim1 , M-H Jeong2 , 1Jeju National University Hospital, Cardiology - Jeju - Korea Republic of , 2Chonnam National University Hospital, Cardilogy - Gwangju - Korea Republic of ,

On behalf: KAMIR-NIH investigators

Citation:

Background and purposes; There has been a long debate about "J-curve phenomenon" in the management of patients with hypertension, especially who have cardiovascular diseases. The blood pressure (BP) lower or higher than optimal level may be harmful in hypertensive patients with acute myocardial infarction (AMI). This study aimed to investigate the association between 6-month BP level and 1-year readmission due to heart failure (re-HF) in hypertensive patients with AMI.

Methods; Among 13,104 patients who enrolled in nationwide AMI database of South Korea, the KAMIR-NIH Registry, 4,216 hypertensive patients, who survived the initial attack and had 6-month BP data, were selected in this study. They were divided into six systolic or diastolic BP groups according to BP levels (Table).

Results; Lowest 6-month systolic BP group of <110 mmHg or lowest 6-month diastolic BP group of <65 mmHg showed the highest re-HF at 1-year (6.9 ± 1.1% and 8.0 ± 1.0%, respectively) (Figure). On multivariate Cox-proportional hazard analysis, patients with lowest systolic BP (OR; 2.01, 95% CI; 1.17-3.44, p=0.011) or lowest diastolic BP (OR; 4.04, 95% CI; 1.84-8.97, p=0.001) had the highest re-HF at 1-year compared with optimal level of BP. Higher diastolic BP than optimal level also increased re-HF. Even after excluding patients with re-HF before 6 months, patients with lowest systolic BP (OR; 2.09, 95% CI; 1.19-3.67, p=0.010) or lowest diastolic BP (OR; 3.98, 95% CI; 1.80-8.79, p=0.001) at 6- month showed the greatest risk for re-HF at 1-year.

Conclusions; Systolic BP lower than optimal level, and diastolic BP lower or higher than that at 6-month, increased re-HF at 1-year in hypertensive patients with AMI.

SBP (mmHg)

No.

HR

95% CI

p value

DBP (mmHg)

No.

HR

95% CI

p value

<110

521

2.01

1.17-3.44

0.011

<65

779

4.07

1.84-8.97

0.001

110-119

681

1.59

0.93-2.74

0.091

65-74

1,268

2.48

1.11-5.53

0.027

120-129

988

1.00

Reference

75-79

588

1.00

Reference

130-139

951

1.36

0.79-2.34

0.272

80-84

749

4.04

1.75-9.33

0.001

140-149

576

1.37

0.75-2.49

0.307

85-89

360

1.58

0.50-5.00

0.435

≥150

499

0.91

0.46-1.80

0.792

≥90

472

3.07

1.20-7.84

0.019

Multivariate Cox-proportional hazard analysis including age, sex, body mass index, diabetes, prior angina, prior myocardial infarction, prior heart failure, Killip class, smoking, chronic kidney disease, beta-blockers, inhibitors of renin-angiotensin system, statins, left ventricular ejection fraction, and ST-elevation myocardial infarction

DBP; diastolic blood pressure, CI; confidence interval, HR; hazard ratio, SBP; systolic blood pressure

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From 1 August onwards, support our mission by becoming a member.



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