Background Hypertension was an independent risk factor for affecting the prognosis of patients with ACS. But the effect of blood pressure levels at admission on prognosis in ACS patients without history of hypertension was not clear.
Methods The DESIRE-2(Drug-Eluting Stent Impact on Revascularization-2) was a single-center registry of coronary revascularization in our institution between July 1st 2003 and Sep 30th 2005. The study excluded the patients with prior history of hypertension and myocardial infarction, the patients admitted to hospital with ST-segment elevated myocardial infarction and stable coronary artery disease, and the patients without detailed document record. Major adverse cardiac and cerebral events (MACCE) were the combination endpoint of all-cause death, non-fatal myocardial infarction, non-fatal stroke and revascularization.
Results The study enrolled 982 patients and divided into three groups according to the first measurement of blood pressure levels at admission. The 207 patients with blood pressure less than 120/80 mm Hg defined as normal blood pressure group, 209 patients with blood pressure more than 140/90 mm Hg as hypertension group, other patients as prehypertension group. Among three groups, there was no difference in age, gender, prior history of diabetes mellitus, coronary revascularization and smoking, body mass index, left ventricular ejection fraction, the levels of glomerular filtration rate, haemoglobin, total cholesterol, low density lipoprotein cholesterin, fasting glucose, glycolated haemoglobin. Severity of coronary artery and utilisation ratio of aspirin, β blocker, calcium channel blocker were similar in three groups. More patients taken statins (67.7%, 55.3%, 58.3%, p=0.013) and ACEI (41.1%, 27.6%, 27.8%, p=0.002) during the hospitalisation in hypertension group. Duration of follow-up in the normal, prehypertension and hypertension group was 522 days, 539 days and 523 days respectively. The in-hospital MACCE rates was similar in three groups, but higher follow-up MACCE rates (11.0%, 5.7%, 9.5%, p=0.035) and follow-up mortality rates (2.6%, 0.8%, 0%, p=0.026) in hypertension group.
Conclusion The higher blood pressure levels at admission in non ST-segment elevated ACS patients without prior history of hypertension had poorer prognosis, but the history and clinical features were similar to patients with normal blood pressure.