Hypertension and acute myocardial infarction:  an overview.
History of hypertension is a frequent finding in patients with acute myocardial infarction (AMI) and its recurring association with female sex, diabetes, older age, less frequent smoking and more frequent vascular comorbidities composes a risk profile quite distinctive from the normotensive ischemic counterpart.Antecedent hypertension associates with higher rates of death and morbid events both during the early and long-term course of AMI, particularly if complicated by left ventricular dysfunction and/or congestive heart failure. Renin-angiotensin-aldosterone system blockade, through either angiotensin-converting enzyme inhibition, angiotensin II receptor blockade or aldosterone antagonism, exerts particular benefits in that high-risk hypertensive subgroup.In contrast to the negative implications carried by antecedent hypertension, higher systolic pressure at the onset of chest pain associates with lower mortality within 1 year from coronary occlusion, whereas increased blood pressure recorded after hemodynamic stabilization from the acute ischemic event bears inconsistent relationships with recurring coronary events in the long-term follow-up.Whether antihypertensive treatment in post-AMI hypertensive patients prevents ischemic relapses is uncertain. As a matter of fact, excessive diastolic pressure drops may jeopardize coronary perfusion and predispose to new acute coronary events, although the precise cause-effect mechanisms underlying this phenomenon need further evaluation.
Dipartimento Cardio Toracico e Vascolare, Universita' Di Pisa, 56100 Pisa, Italy. r.pedrinelli@med.unipi.it
Roberto
R
Pedrinelli
Piercarlo
P
Ballo
Cesare
C
Fiorentini
Silvia
S
Denti
Maurizio
M
Galderisi
Antonello
A
Ganau
Giuseppe
G
Germanò
Pasquale
P
Innelli
Anna
A
Paini
Stefano
S
Perlini
Massimo
M
Salvetti
Valerio
V
Zacà
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D000959:Antihypertensive Agents