Comparison of patients with acute coronary syndrome with and without systemic hypertension.
The role of systemic hypertension in acute coronary syndrome (ACS) has not been well studied. We studied consecutive subjects admitted to the University of Michigan Health System (Ann Arbor, Michigan) with symptoms of ACS. Data were collected using a standardized form. This observational study is currently ongoing; we collected data from May 1999 to December 2000 for 979 subjects, 890 of whom also had 6-month follow-up data. Hypertensives represented 64.4% (n = 630) of the total population. In general, hypertensive patients were older than normotensives (66.3 vs 59.9 years, p <0.0001), more often women (38.7% vs 26.9%, p = 0.0002), and had more comorbidities, such as previous myocardial infarction (47.9% vs 33.8%, p <0.0001), congestive heart failure (25.7% vs 12.0%, p <0.0001), and diabetes (36.9% vs 17.8%, p <0.0001). At admission, hypertensives had higher systolic blood pressure. Hypertensives had fewer electrocardiographic abnormalities indicating ischemic changes (67.9% vs 76.3%, p = 0.01) and had fewer incident of acute myocardial infarction (AMI) (70.7% vs 76.1%, p = 0.07) than normotensives. There was consistency over different levels of admission systolic blood pressure. Hypertensives received more oral cardiovascular drugs, and had undergone more invasive procedures. The lower rate of AMI in hypertensives seemed to be related to the higher frequency of a history of percutaneous coronary intervention and coronary artery bypass grafting. However, at 6-month follow-up, age- and gender-adjusted odds ratios for adverse events were equivalent in hypertensives and normotensives, suggesting no continuing differential treatment benefit for hypertensives in the months after the initial ACS episode.
Majahalme
Silja K
SK
Tampere University Hospital, Tampere, Finland. silja.majahalme@thedacare.org
Smith
Dean E
DE
Cooper
Jeanna V
JV
Kline-Rogers
Eva
E
Mehta
Rajendra H
RH
Eagle
Kim A
KA
Bisognano
John D
JD
D000208:Acute Disease; D017677:Age Distribution; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003402:Creatine Kinase / Q000032:analysis; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016017:Odds Ratio; D012016:Reference Values; D012044:Regression Analysis; D017678:Sex Distribution; D013577:Syndrome; D019210:Troponin I / Q000032:analysis
D015415:Biomarkers; D002317:Cardiovascular Agents; D019210:Troponin I; D003402:Creatine Kinase