History of hypertension and eplerenone in patients with acute myocardial infarction complicated by heart failure.
In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (n=6632), eplerenone-associated reduction in all-cause mortality was significantly greater in those with a history of hypertension (Hx-HTN). There were 4007 patients with Hx-HTN (eplerenone: n=1983) and 2625 patients without Hx-HTN (eplerenone: n=1336). Propensity scores for eplerenone use, separately calculated for patients with and without Hx-HTN, were used to assemble matched cohorts of 1838 and 1176 pairs of patients. In patients with Hx-HTN, all-cause mortality occurred in 18% of patients treated with placebo (rate, 1430/10 000 person-years) and 14% of patients treated with eplerenone (rate, 1058/10 000 person-years) during 2350 and 2457 years of follow-up, respectively (hazard ratio [HR]: 0.71; 95% CI: 0.59 to 0.85; P<0.0001). Composite end point of cardiovascular hospitalization or cardiovascular mortality occurred in 33% of placebo-treated patients (3029/10 000 person-years) and 28% of eplerenone-treated patients (2438/10 000 person-years) with Hx-HTN (HR: 0.82; 95% CI: 0.72 to 0.94; P=0.003). In patients without Hx-HTN, eplerenone reduced heart failure hospitalization (HR: 73; 95% CI: 0.55 to 0.97; P=0.028) but had no effect on mortality (HR: 0.91; 95% CI: 0.72 to 1.15; P=0.435) or on the composite end point (HR: 0.91; 95% CI: 0.76 to 1.10; P=0.331). Eplerenone should, therefore, be prescribed to all of the post-acute myocardial infarction patients with reduced left ventricular ejection fraction and heart failure regardless of Hx-HTN.
University of Michigan, 1500 E Medical Center Dr, 3910 Taubman Center, Ann Arbor, MI 48109-0366, USA. bpitt@med.umich.edu
Bertram
B
Pitt
Ali
A
Ahmed
Thomas E
TE
Love
Henry
H
Krum
Jose
J
Nicolau
José S
JS
Cardoso
Alexander
A
Parkhomenko
Michael
M
Aschermann
Ramon
R
Corbalán
Henry
H
Solomon
Harry
H
Shi
Faiez
F
Zannad
D000368:Aged; D002423:Cause of Death; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D000077545:Eplerenone; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage*; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D013148:Spironolactone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016019:Survival Analysis; D016896:Treatment Outcome
D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone