title: High pulse pressure and low mean arterial pressure: two predictors of death after a myocardial infarction.
abstract: OBJECTIVE
  Although the negative prognostic implication of a clinical history of arterial hypertension in myocardial infarction (MI) survivors is well known, the predictive role of the blood pressure (BP) regimen after MI is not well defined. The aim of this study was to investigate the prognostic significance of different BP indices in post-MI.
  
  
  RESULTS
  We evaluated the relationship between baseline systolic, diastolic, pulse and mean arterial pressure (MAP), measured by sphygmomanometry at discharge from hospital or within 3 months of an MI, and total and cardiovascular mortality in 11 116 patients enrolled in the GISSI-Prevenzione trial. Over 3.5 years of follow-up, 999 patients died, 657 of them from cardiovascular causes. Low mean and high pulse pressure were significantly associated with total and cardiovascular mortality after controlling for potential confounders in the multivariate analysis. As compared with patients with less extreme BP values, patients with MAP of 80 mmHg or less (n = 1241; 11.2%) had a 48% higher risk of cardiovascular death [95% confidenceinterval (CI) 1.16-1.87; P = 0.001] and those with pulse pressure greater than 60 mmHg (n = 958; 8.6%) had a 35% higher risk (95% CI 1.09-1.69; P = 0.007); only four subjects (0.04%) had both a high pulse pressure and a low MAP (relative risk of cardiovascular death 3.48; 95% CI 0.48-25.88; P = 0.218).
  
  
  CONCLUSIONS
  Our results show for the first time an additional prognostic importance of two easily measurable components of BP, definitely high pulse pressure (> 60 mmHg) and low MAP (< or = 80 mmHg), in a large sample of non-selected patients surviving MI who entered a modern programme of cardiovascular prevention.
authors.affiliation: Department of Cardiovascular Research, Istituto Mario Negri, Milan, Italy. marchioli@negrisud.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Avanzini
authors.forename: Claudio
authors.initials: C
authors.lastname: Alli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Boccanelli
authors.forename: Carmine
authors.initials: C
authors.lastname: Chieffo
authors.forename: Maria G
authors.initials: MG
authors.lastname: Franzosi
authors.forename: Enrico
authors.initials: E
authors.lastname: Geraci
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Marfisi
authors.forename: Gian L
authors.initials: GL
authors.lastname: Nicolosi
authors.forename: Carlo
authors.initials: C
authors.lastname: Schweiger
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Franco
authors.initials: F
authors.lastname: Valagussa
authors.forename: Roberto
authors.initials: R
authors.lastname: Marchioli
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007022:Hypotension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D011379:Prognosis; D012307:Risk Factors