Antecedent hypertension and heart failure after myocardial infarction.
OBJECTIVE
We sought to assess the relationship of antecedent hypertension to neurohormones, ventricular remodeling and clinical heart failure (HF) after myocardial infarction (MI).


BACKGROUND
Heart failure is a probable contributor to the increased mortality observed after MI in those with antecedent hypertension. Hence, neurohormonal activation, adverse ventricular remodeling and a higher incidence of clinical HF may be expected in this group. However, no previous report has documented serial postinfarction neurohumoral status, serial left ventricular imaging and clinical outcomes over prolonged follow-up in a broad spectrum of patients with and without antecedent hypertension.


METHODS
Inpatient events were documented in 1,093 consecutive patients (436 hypertensive and 657 normotensive) with acute MI. In 68% (282 hypertensive, 465 normotensive) serial neurohormonal sampling and radionuclide ventriculography were performed one to four days and three to five months after infarction. Clinical outcomes were recorded over a mean follow-up of two years.


RESULTS
Plasma neurohormones were significantly higher in hypertensives than in normotensives one to four days and three to five months after infarction. From similar initial values, left ventricular volumes increased significantly in hypertensives, compared with normotensives. Left ventricular ejection fraction rose significantly in normotensive but not hypertensive patients. Together with higher inpatient (8.1% vs. 4.4%, p < 0.002) and post-discharge mortality (9.5% vs. 5.5%, p = 0.043), hypertensive patients incurred more inpatient HF (33% vs. 24%, p < 0.001) and more late HF requiring readmission to hospital (12.4% vs. 5.5%, p < 0.001). Antecedent hypertension predicted late HF in patients >64 years of age with neurohormonal activation and early left ventricular dilation.


CONCLUSIONS
Antecedent hypertension interacts with age, neurohumoral activation and early ventricular remodeling to confer greater risk of HF after MI.
Richards
A Mark
AM
Cardiology, Christchurch Hospital, Christchurch, New Zealand. barbara.griffin@chmeds.ac.nz
Nicholls
M Gary
MG
Troughton
Richard W
RW
Lainchbury
John G
JG
Elliott
John
J
Frampton
Christopher
C
Espiner
Eric A
EA
Crozier
Ian G
IG
Yandle
Timothy G
TG
Turner
John
J
D000367:Age Factors; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D018377:Neurotransmitter Agents / Q000097:blood*; D011877:Radionuclide Imaging; D012307:Risk Factors; D013997:Time Factors; D020257:Ventricular Remodeling / Q000502:physiology*
D018377:Neurotransmitter Agents