Antihypertensive therapy at the onset of an acute myocardial infarction predicts in-hospital mortality.
Several studies, which have compared the efficacy of conventional antihypertensive drugs (thiazide diuretics and beta-blockers) with the newer agents [calcium blockers and angiotensin-converting enzyme (ACE) inhibitors], have shown that they are almost equally efficacious with regard to effects on blood pressure, and in preventing cardiovascular morbidity and mortality. The potential value of these drugs when hypertensive patients suffer an acute myocardial infarction (AMI) has, however, not been fully elucidated. The objective of the present observational study was to investigate whether prior use of different antihypertensive drugs could modify or influence in-hospital death in hypertensives suffering an AMI. A total of 299 hypertensive patients with the diagnosis of AMI were included. The demographic data were obtained from medical records. Variables were entered into a logistic regression model. The main predictors of death were age (adjusted odds ratio (ORa) 1.07, p = 0.002 (per each year), and the use of diuretics (ORa 2.54, p = 0.018) and calcium blockers (ORa 2.54, p = 0.010). On the other hand, the use of ACE inhibitors was associated with a marked reduction of in-hospital death (ORa 0.44, p = 0.045). The present study indicates that while the use of ACE inhibitors was associated with a reduced risk of in-hospital death in hypertensive patients suffering an AMI, the use of diuretics and calcium blockers was associated with increased risks.
Landmark
Knud
K
Department of Pharmacotherapeutics, University of Oslo, Oslo, Norway. k.h.landmark@labmed.uio.no
Aursnes
Ivar
I
Kvan
Elena
E
Reikvam
Asmund
A
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D000704:Analysis of Variance; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D004232:Diuretics; D004363:Drug Utilization / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D009574:Nitro Compounds / Q000494:pharmacology / Q000627:therapeutic use; D010343:Patient Admission / Q000706:statistics & numerical data; D011945:Receptors, Angiotensin / Q000627:therapeutic use; D012189:Retrospective Studies; D049993:Sodium Chloride Symporter Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D015996:Survival Rate; D013997:Time Factors; D014859:Warfarin / Q000494:pharmacology / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers; D004232:Diuretics; D009574:Nitro Compounds; D011945:Receptors, Angiotensin; D049993:Sodium Chloride Symporter Inhibitors; D014859:Warfarin; D001241:Aspirin