In-hospital complications of acute myocardial infarction in hypertensive subjects.
BACKGROUND
Recent studies have shown a worse in-hospital outcome in hypertensive than in normotensive patients with acute myocardial infarction (AMI), which has been attributed to more frequent complications. The aim of this study was to investigate clinical patterns, risk factors, and in-hospital complications in hypertensive and normotensive patients with AMI.


METHODS
Of 4994 consecutive patients with AMI admitted to the intensive care unit, hypertensive patients with first infarction (n = 915; mean age 68.8 +/- 11.4 years) and 915 gender- and age-matched normotensive subjects were retrospectively studied.


RESULTS
In the univariate analysis, hypertensive subjects presented more frequently non-Q-wave infarction and ST segment depression than did normotensive subjects, even if hypertensive subjects more frequently had diabetes, dyslipidemia, renal failure, peripheral artery disease, cerebrovascular disease, and chronic obstructive pulmonary disease (P < .01 for all). Hypertensive subjects less frequently presented with cardiogenic shock (4.0% v 11.6%; P < .01), atrioventricular block (4.9% v 7.4%; P = .02), ventricular fibrillation (2.2% v 3.7%; P = .04), cardiac rupture (0.1% v 0.9%; P = .02), and ventricular thrombosis (0.5% v 1.5%; P < .03), and a higher frequency of paroxysmal atrial fibrillation (9.2 v 5.6%; P < .01). Mortality was significantly higher in patients with anterior versus inferior infarction, for all normotensive and hypertensive subjects (13.7% v 7.1%; P < .001), but mortality was remarkably higher in normotensive than in hypertensive subjects (17.8% v 6.2%; P < .001), regardless of infarction site (anterior, 11.2% v 4.1%; P < .001; inferior, 4.4% v 1.9%; P < .001).


CONCLUSIONS
Hypertensive subjects with first AMI have a better in-hospital outcome than age- and gender-matched normotensive subjects, perhaps due to a less severe extension of the infarction area or to a different pathophysiologic mechanism.
Abrignani
Maurizio G
MG
Division of Cardiology, Hospital S. Antonio of Trapani, Trapani, Italy.
Dominguez
Ligia J
LJ
Biondo
Giambattista
G
Di Girolamo
Alberto
A
Novo
Giuseppina
G
Barbagallo
Mario
M
Braschi
Annabella
A
Braschi
Giambattista
G
Novo
Salvatore
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003325:Coronary Care Units; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies
D000959:Antihypertensive Agents