Measures of blood pressure and myocardial infarction in treated hypertensive patients.
OBJECTIVE
To identify entry characteristics associated with subsequent myocardial infarction in treated hypertensive patients.


METHODS
Nested case-control study and cohort study.


METHODS
The 5730 participants (mean age 53 years; 61% male and 45% Caucasian) were selected from a worksite-based, union-sponsored, systematic hypertension control program from 1973 to 1992.


METHODS
In the case-control study myocardial infarction cases were matched by age, sex, year of entry to the program, years of follow-up and previous treatment status (treated or untreated) with non-event subjects. Baseline clinical and biochemical characteristics were analyzed with regard to the outcome of myocardial infarction, using univariate and multivariate analyses, respectively, in case-control and cohort studies.


RESULTS
During 5.43 years of follow-up the incidence of myocardial infarction was 6.75/1000 person-years. Univariate analysis indicated that myocardial infarction cases had higher cholesterol level and were more likely to have a previous history of diabetes than controls. The initial systolic blood pressure and pulse pressure of cases were significantly higher than in controls. Logistic regression models indicated that initial pulse pressure, either as a continuous or as a categorical variable, was the only measure of blood pressure independently associated with myocardial infarction after adjustment for other risk factors. Analysis of the experience of the total 5730 as well as 2445 previously untreated patients with a cohort study generated identical results.


CONCLUSIONS
A large pulse pressure difference appears to be the most powerful measure available of initial blood pressure to identify, in advance, those hypertensive patients at greatest risk for a subsequent myocardial infarction.
Fang
J
J
Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, New York 10461, USA.
Madhavan
S
S
Cohen
H
H
Alderman
M H
MH
D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology*; D001806:Blood Urea Nitrogen; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology*; D011446:Prospective Studies; D011674:Pulse; D012307:Risk Factors; D012737:Sex Factors
D001786:Blood Glucose; D002784:Cholesterol; D003404:Creatinine