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Association between 1-year blood pressure level and 1-year heart failure events in hypertensive patients with acute myocardial infarction
Authors : MS Kim (Jeju,KR), JW Beom (Jeju,KR), JH Choi (Jeju,KR), SY Kim (Jeju,KR), KS Kim (Jeju,KR), SJ Joo (Jeju,KR), JG Lee (Jeju,KR), SW Rha (Seoul,KR), JO Jeong (Daejeon,KR), SC Chae (Daegu,KR), DJ Choi (Seongnam,KR), YJ Kim (Daegu,KR), KB Kim (Daegu,KR), JK Chae (Jeonju,KR), MH Jeong (Gwangju,KR)
1Jeju National University Hospital, internal medicine - Jeju - Korea (Republic of)
2Korea University Guro Hospital, Cardiology - Seoul - Korea (Republic of)
3Chungnam National University Hospital, Cardiology - Daejeon - Korea (Republic of)
4Kyungpook National University Hospital, Cardiology - Daegu - Korea (Republic of)
5Seoul National University Bundang Hospital, Cardiology - Seongnam - Korea (Republic of)
6Yeungnam University Hospital, Cardiology - Daegu - Korea (Republic of)
7Keimyung University Hospital Dongsan Medical Center, Cardiology - Daegu - Korea (Republic of)
8Chonbuk National University Hospital, Cardiology - Jeonju - Korea (Republic of)
9Chonnam National University Hospital, Cardiology - Gwangju - Korea (Republic of)
Background;Hypertension is the most prevalent modifiable risk factor for the development of heart failure (HF). Elevated blood pressure (BP) increases the pressure load on the left ventricle, causing systolic and diastolic dysfunction of the left ventricle and promoting left ventricular remodeling.In recent study, systolic BP and diastolic BP lower or higher than optimal level increased clinical events in hypertensive patients with stable coronary artery disease. This study aimed to investigate the association between 1-year BP level and 1-year HF events in hypertensive patients with acute myocardial infarction (AMI).
Methods;Among 13,104 patients who enrolled in nationwide AMI database of South Korea, the KAMIR-NIH Registry, 4,166 hypertensive patients, who had 1-year BP data, were selected in this study. They were divided into six systolic or diastolic BP groups according to BP levels.
Results;Lowest 1-year systolic BP group of <110 mmHg had the highest 1-year readmission due to heart failure (7.6± 1.4%). Lowest 1-year diastolic BP group of <65 mmHg also showed the highest 1-year re-hospitalization due to heart failure (7.0 ± 0.9%). On univariate and multivariate Cox-proportional hazard analysis with 1-year systolic BP 130-139 mmHg or diastolic BP 90-99 mmHg as a reference respectively, lower systolic BP (<110 and 110~119 mmHg) or diastolic BP (<70 and 70~79 mmHg) than reference group increased 1-year re-hospitalization due to heart failure. However, on multivariate analysis including age, gender, Killip class, renal function, and left ventricular systolic function, lowest systolic BP and lowest diastolic BP was a significant risk factor for 1-year re-hospitalization due to heart failure.
Conclusion;Systolic and diastolic BP lower than optimal level at 1-year increased 1-year re-hospitalization due to heart failure in hypertensive patients with AMI.
Table. Multivariate Cox-proportional hazards analysis for 1-year rehospitalization due to heat failure according to blood pressure
BP; blood pressure, CI; confidence interval, HR; hazard ratio
*Multivariate Cox-proportional hazard analysis including age, sex, BMI, DM, prior angina, prior MI, prior HF, Killip class, smoking, CKD, beta-blockers, inhibitors of RAS, statins, LV ejection fraction, and STEMI as co-variates
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