Relation of early and one-year outcome after acute myocardial infarction to systemic arterial blood pressure on admission

We evaluated whether elevated blood pressure (BP) levels with an acute myoc ardial infarction (AMI) affect the in-hospital course, short-term, and 1-ye ar outcome. Data were derived from a nationwide survey of 2,212 consecutive patients with AMI. Patients were stratified into 3 groups according to adm ission BP levels: 1,320 patients had normal BP, 840 patients had high BP, a nd 52 patients had excessive BP. In-hospital (7 days) course, short-term (3 0 days), and 1-year outcome was compared between the groups. The 3 groups w ere similar with respect to age, but patients with excessive BP were more l ikely to be women and have a history of systemic hypertension and diabetes mellitus. The rate of thrombolytic therapy was similar among the 3 groups, but patients with excessively elevated BP were treated during hospitalizati on much more often with beta blockers, angiotensin-converting enzyme inhibi tors, and diuretics. The incidence of stroke, transient ischemic attack, an d bleeding complications were comparable in the 3 groups. In-hospital morta lity was 5.0%, 4.0%, and 1.9% in the normal, high, and excessively elevated BP groups, respectively (p = 0.19). The short-term rehospitalization or mo rtality rate was similar among the 3 groups. The I-year mortality rate was 12.3%, 14.1%, and 10.2% in the normal, high, and excessively elevated BP gr oups, respectively (p = 0.61). A multivariate logistic regression analysis yielded age, women, and Killip class greater than or equal to 2 as the only significant predictors of mortality during follow-up. Thus, with the curre nt medical therapy, excessively elevated BP levels with AMI is not associat ed with a worse short-term or 1-year outcome. (C) 1999 by Excerpta Medica, Inc.