Copyright © 1998 by the European Society of Cardiology.
Long-term prognosis after acute myocardial infarction in patients with a history of arterial hypertension
a Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Frederiksberg
b Department of Cardiology, Gentofte University Hospital, Gentofte
c Department of Cardiology, Glostrup University Hospital, Glostrup
d Medicon, Copenhagen, Denmark
accepted October 13, 1997
Aims
The objective of the study was to investigate the influence of a history of arterial hypertension on long-term prognosis after an acute myocardial infarction in a representative population, and secondly to assess the impact on prognosis of left ventricular systolic function in hypertensives after acute myocardial infarction.
Methods
A retrospective analysis of survival data on 6676 patients with acute myocardial infarction screened for entry into the TRAndolapril Cardiac Evaluation (TRACE) study. Follow-up time was 4–6 years.
Results
One thousand five hundred and seven (23%) of the patients had a history of arterial hypertension. During the time of observation 763 (50·6%) hypertensives and 2253 (43·7%) normotensives died, corresponding to a risk ratio for death in hypertensives of 1·23 (1·13–1·33, P<0·0001). In a multivariate analysis considering 12 other major risk factors after myocardial infarction, the risk ratio for death in hypertensives was 1·14 (1·04–1·24). There was a sig-nificant interaction between hypertension and age. Thus, hypertension only increased risk in patients aged 65 years or less (P<0·001). No interaction with left ventricular systolic function was found.
Conclusion
A history of arterial hypertension is a moderate risk factor for mortality after an acute myo-cardial infarction in patients aged 65 years or less. This excess risk is present at all levels of left ventricular systolic function.
Key Words: myocardial infarction • hypertension • prognosis • mortality • left ventricular function • risk stratification
f1 Correspondence: Finn Gustafsson, MD, Department of Medical Physiology, University of Copenhagen, The Panum Institute 10.5 Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
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