Canadian Journal of Cardiology, 2020.36, 1641-1648, DOI: https://doi.org/10.1016/j.cjca.2020.01.026

Blood Pressure at Six Months after Acute Myocardial Infarction and Outcomes at Two Years: The Perils Associated with Excessively Low Blood Pressures

Pil Sang Song, Ki-Hyun Jeon; Joo-Yong Hahn; Seung-Ho Hur; Seung-Woon Rha; Chang-Hwan Yoon; Myung Ho Jeong; Jin-Ok Jeong; In-Whan Seong; Young Bin Song; Hyeon-Cheol Gwon\

Abstract

Background: This study aimed to determine the association between achieved blood pressure at 6-month follow-up and cardiovascular outcomes at 2 years in patients treated with β-blockers and renin-angiotensin-aldosterone blockers after acute myocardial infarction (AMI).
Methods: We analyzed data from 5503 patients enrolled in the national AMI registry. Patients with myocardial reinfarction (MrI), rehospitalization for heart failure (rHHF), or stroke before 6-month follow-up were excluded. Achieved blood pressures were categorized into 10-mm Hg increments. The primary outcome was all-cause death. The secondary outcome was a composite of all-cause death, MrI, and rHHF. Hazard ratios (HRs) were estimated with multivariable-adjusted Cox hazards models using 125- to 134-mm Hg systolic blood pressure (SBP) and 75- to 84-mm Hg diastolic blood pressure (DBP) subgroups as reference.
Results: After a median follow-up of 2.1 years, SBP < 115 mm Hg was associated with increased risks for all-cause death (adjusted HR: 2.202 [1.158-4.188]) and for a composite outcome (HR: 1.682 [1.075-2.630]). Likewise, DBP < 75 mm Hg tended to be associated with an increase in all-cause death (HR: 2.078 [0.998-4.327] for DBP of 65 to 74 mm Hg; HR: 2.610 [1.256-5.423] for DBP < 65 mm Hg). Even in patients <75 years, the risk of a composite outcome was increased for DBP < 65 mm Hg (HR: 2.492 [1.401-4.434]).
Conclusions: Low blood pressure achieved with β-blocker and renin-angiotensin-aldosterone blocker at 6 months was associated with an increased risk of all-cause mortality independently of confounding factors in patients with AMI. This finding suggests that caution should be taken for patients with AMI who use blood-pressure-lowering treatments.

• DOI: https://doi.org/10.1016/j.cjca.2020.01.026
• ISBN or ISSN: 0828-282X

• 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
• This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.