The prognostic significance of a history of systemic hypertension in patients randomised to either placebo or ramipril following acute myocardial infarction: evidence from the AIRE study

Background: After acute myocardial infarction (AMI), patients with a histor y of arterial hypertension (AH) have a worse prognosis than normotensives. Whether this adverse risk is beneficially modulated by treatment with angio tensin-converting enzyme (ACE) inhibitors is unknown. We evaluated the prog nostic value of antecedent hypertension in post-AMI patients given ACE inhi bitor therapy. Methods: We analysed retrospectively data from the AIRE study (randomised, placebo-controlled trial of ramipril in 2006 post-AMI patients with clinica l heart failure). A history of AH was present in 28% of the patients. We ex amined the prognostic value of antecedent hypertension separately among pla cebo and ramipril treated patients and also the effect of ramipril on clini cal outcomes according to whether or not a history of AH was present. Results: Antecedent hypertension was a significant indicator of adverse pro gnosis in the placebo (P) treated patients (Hazard Ratio 1.49, 95% Confiden ce Intervals 1.13 to 1.97, P = 0.005) but not in the ramipril (R) treated p atients (1.17, 0.84 to 1.61, P = 0.34). A similar pattern was observed for the risks of sudden death (P: 1.75, 1.21 to 2.54, P = 0.003; R: 1.34, 0.86 to 2.07, P = 0.18) and severe/resistant heart failure (P: 1.48, 1.08 to 2.0 3, P = 0.014; R: 1.18, 0.83 to 1.68, P = 0.37). Treatment with ramipril red uced the all-cause mortality risk in both hypertensive (0.63, 0.44 to 0.89, P = 0.009) and normotensive patients (0.78, 0.61 to 0.99, P = 0.041). Conclusion: Antecedent hypertension is not a significant prognosticator in patients with AMI and clinical heart failure given ACE inhibitor therapy.