LONG-TERM PROGNOSIS AFTER ACUTE MYOCARDIAL-INFARCTION IN PATIENTS WITH A HISTORY OF ARTERIAL-HYPERTENSION

Aims The objective of the study was to investigate the influence of a history of arterial hypertension on longterm prognosis after an acute myocardial infarction in a representative population, and secondly to assess the impact on prognosis of left ventricular systolic function i n hypertensives after acute myocardial infarction. Methods A retrospec tive 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 fiv e hundred and seven (23%) of the patients had a history of arterial hy pertension. During the time of observation 763 (50.6%) hypertensives a nd 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 multivariat e analysis considering 12 other major risk factors after myocardial in farction, the risk ratio for death in hypertensives was 1.14 (1.04-1.2 4). There was a significant interaction between hypertension and age. Thus, hypertension only increased risk in patients aged 65 years or le ss (P<0.001). No interaction with left ventricular systolic function w as found. Conclusion A history of arterial hypertension is a moderate risk factor for mortality after an acute myocardial infarction in pati ents aged 65 years or less. This excess risk is present at all levels of left ventricular systolic function.