Impact of hypertension on the outcome of patients admitted with acute coronary syndrome.
OBJECTIVE
The role of hypertension and its impact on outcome in patients with acute coronary syndrome (ACS) is still debated. This study aimed to compare the outcomes of hypertensive and nonhypertensive ACS patients.


METHODS
Using data of ACS patients enrolled in the Acute Myocardial Infarction in Switzerland Plus Registry from 1997 to 2013, characteristics at presentation and outcomes in hospital and after 1 year were analyzed. Hypertension was defined as previously diagnosed and treated by a physician. The primary endpoint was mortality. Data were analyzed using multiple logistic regressions.


RESULTS
Among 41 771 ACS patients, 16 855 (40.4%) were without and 24 916 (59.6%) with preexisting hypertension. Patients with preexisting hypertension had a more favorable in-hospital outcome [odds ratio (OR) in-hospital mortality 0.82, 95% confidence interval (CI) 0.73-0.93; P = 0.022]. The independent predictors of in-hospital mortality for patients with preexisting hypertension were age, Killip class greater than 2, Charlson Comorbidity Index greater than 1, no pretreatment with statins and lower admission systemic blood pressure. Preexisting hypertension was not an independent predictor of 1-year mortality in the subgroup of patients (n = 7801) followed: OR 1.07, 95% CI 0.78-1.47; P = 0.68. Independent predictors of mortality 1 year after discharge for the 4796 patients with preexisting hypertension were age, male sex and comorbidities. Angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists and statins prescribed at discharge improved the outcomes.


CONCLUSIONS
Outcome of ACS patients with preexisting hypertension was associated with an improved in-hospital prognosis after adjustment for their higher baseline risk. However, this effect was not long-lasting and does not necessarily mean a causal relationship exists. Short-term and long-term management of patients with hypertension admitted with ACS could be further improved.
aAMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich bClinic St. Anna, Lucerne cDepartment of Cardiology, University Hospital Zurich, Zurich dDivision of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern eCardiology Centre, Klinik im Park, Zurich fDepartment of Medicine, Kantonsspital Obwalden, Sarnen gDepartment of Medicine, Spital STS AG Zweisimmen, Zweisimmen hDepartment of Medicine, University Hospital, Geneva, Switzerland.
Paul
P
Erne
Dragana
D
Radovanovic
Andreas W
AW
Schoenenberger
Osmund
O
Bertel
Thomas
T
Kaeslin
Manfred
M
Essig
Jean-Michel
JM
Gaspoz
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012042:Registries; D013557:Switzerland / Q000453:epidemiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors