Long-term prognosis after acute myocardial infarction in patients with a history of arterial hypertension. TRACE study group.
OBJECTIVE
The objective of the study was to investigate the influence of a history of arterial hypertension on long-term prognosis after an acute myocardial infarction in a representative population, and secondly to assess the impact on prognosis of left ventricular systolic function in hypertensives after acute myocardial infarction.


METHODS
A retrospective analysis of survival data on 6676 patients with acute myocardial infarction screened for entry into the TRAndolapril Cardiac Evaluation (TRACE) study. Follow-up time was 4-6 years.


RESULTS
One thousand five hundred and seven (23%) of the patients had a history of arterial hypertension. During the time of observation 763 (50.6%) hypertensives and 2253 (43.7%) normotensives died, corresponding to a risk ratio for death in hypertensives of 1.23 (1.13-1.33, P < 0.0001). In a multivariate analysis considering 12 other major risk factors after myocardial infarction, the risk ratio for death in hypertensives was 1.14 (1.04-1.24). There was a significant interaction between hypertension and age. Thus, hypertension only increased risk in patients aged 65 years or less (P < 0.001). No interaction with left ventricular systolic function was found.


CONCLUSIONS
A history of arterial hypertension is a moderate risk factor for mortality after an acute myocardial infarction in patients aged 65 years or less. This excess risk is present at all levels of left ventricular systolic function.
Gustafsson
F
F
Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Denmark.
Køber
L
L
Torp-Pedersen
C
C
Hildebrandt
P
P
Ottesen
M M
MM
Sonne
B
B
Carlsen
J
J
D017677:Age Distribution; D000368:Aged; D003718:Denmark / Q000453:epidemiology; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis