PROGNOSTIC-SIGNIFICANCE OF HYPERTENSION AND ALBUMINURIA FOR EARLY MORTALITY AFTER ACUTE MYOCARDIAL-INFARCTION

Objective To assess the risk of mortality associated with hypertension and microalbuminuria in patients with acute myocardial infarction. De sign A prospective study. Setting Intensive care units in three Italia n general hospitals. Patients In total 309 consecutive patients (inclu ding 97 women) aged 66.6 +/- 12.5 years, admitted to hospital for acut e myocardial infarction. Main outcome measures Albumin excretion rate measured by radioimmunoassay of 24 h urine samples, on the first and t hird days after admission to hospital. In-hospital mortality rate amon g the patients stratified according to their history of hypertension a nd albumin excretion rate. Results Of the patients, 147 had histories of hypertension. Forty-four per cent of the normotensive and 43% of th e hypertensive subjects had microalbuminuria on the first day. On the third day the percentages were 25 and 29%, respectively. Twenty-two pa tients died before discharge from hospital. Patients were divided into four groups according to whether they had microalbuminuria or not and likewise for hypertension. Mortality rate among the subjects with hyp ertension and microalbuminuria combined was greater than those among t he other three groups (P< 0.0001 on the first and third days). The rel ative hazard ratio was 11.7 on the first day, and 15.6 on the third da y. In a multivariate Cox's model hypertension and microalbuminuria com bined had a greater predictive power for mortality than either variabl e alone. Killip class, age, and creatinine kinases MB level were other significant predictors of death. Conclusions. These results show that the combination of hypertension and microalbuminuria is associated wi th a greater risk of in-hospital mortality among subjects with acute m yocardial infarction, independently of degree of heart failure and oth er possible confounders. (C) 1998 Lippincott-Raven Publishers.