Blood pressure and survival after myocardial infarction: The Framingham study

doi:10.1016/0002-9149(80)90654-2

The American Journal of Cardiology

Volume 45, Issue 2, February 1980, Pages 326-330

https://doi.org/10.1016/0002-9149(80)90654-2 Get rights and content

Abstract

Blood pressures were routinely obtained biennially from 2,336 men in the Framingham cohort over a 20 year period of follow-up study. During that time 193 men had their first myocardial infarction. Blood pressure after myocardial infarction was unrelated to survival over the next 5 years, but the blood pressure status preceding the infarction was distinctly related to survival, with hypertensive patients having almost three times the mortality of normotensive patients. These results are explained by the two-fold greater risk of death incurred by hypertensive patients who had a substantial decrease in pressure after myocardial infarction compared with that of men who remained hypertensive. The greater the decrease in pressure after myocardial infarction the greater was the mortality. With exclusion of men who experienced a reduction of more than 10 mm Hg in pressure, men with hypertension after myocardial infarction had a five-fold greater risk of mortality than that of normotensive patients.

A decrease in pressure with interim myocardial infarction occurs frequently, even when the influence of age, treatment and regression toward the mean are taken into account. Men who experienced such reductions in pressure had a reduction in vital capacity (not statistically significant) and an increase in heart rate, thus suggesting that poorer myocardial function accounts for the greater mortality.

References (26)

BF Hankey et al.
Evaluating differences in survival between two groups of patients
J Chronic Dis
(1971)
SW Rabkin et al.
Prognosis after acute myocardial infarction: relation to blood pressure values before infarction in a prospective study
Am J Cardiol
(1977)
OW Beard et al.
Initial myocardial infarction among 503 veterans: five year survival
Am J Med
(1960)
GE Honey et al.
Prognostic factors in myocardial infarction
Lancet
(1957)
BA Rosenberg et al.
Acute myocardial infarction in a city hospital. V. Follow-up study of one hundred thirty-one survivors
Am J Cardiol
(1961)
DW Richards et al.
A completed 25-year follow-up of 200 patients with myocardial infarction
J Chronic Dis
(1956)
G Tibblin et al.
Risk factors for myocardial infarction and death due to ischemic heart disease and other causes
Am J Cardiol
(1975)
JO Humphries
Survival after myocardial infarction: prognosis and management
Mod Concepts Cardiovasc Dis
(1977)
NE Breslow
Analysis of survival data under the proportional hazards model
Int Stat Rev
(1975)
FF Rosenbaum et al.
Prognostic value of various clinical and electrocardiographic features of acute myocardial infarction: immediate prognosis
Arch Intern Med
(1941)

JL Juergens et al.

Prognosis of patients surviving first clinically diagnosed myocardial infarction

Arch Intern Med

(1960)

S Pell et al.

Immediate mortality and five-year survival of employed men with a first myocardial infarction

N Engl J Med

(1964)

E Weinblatt et al.

Prognosis of men after first myocardial infarction: mortality and first recurrence in relation to selected parameters

Am J Public Health

(1968)

Cited by (81)

A History of Systemic Hypertension and Incident Heart Failure Hospitalization in Patients With Acute Myocardial Infarction and Left Ventricular Systolic Dysfunction
2009, American Journal of Cardiology
Citation Excerpt :
These findings are important, because despite the receipt of contemporary standard therapy, and well-balanced, well-controlled blood pressure, a history of hypertension was associated with HF hospitalization, an event associated with increased subsequent mortality.14,15 Data from animal and human studies suggest that myocardial remodeling and poor outcomes after AMIs may be mediated by increases in blood pressure and afterload.16,17 However, our matched cohort had well-controlled blood pressure, which was well balanced between the groups.
The associations of a history of hypertension with subsequent outcomes after acute myocardial infarction have not been examined in propensity-matched studies. Of the 6,632 patients with acute myocardial infarctions and left ventricular systolic dysfunction in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS), 4,407 had histories of hypertension. Propensity scores for a history of hypertension, estimated for each patient using 64 baseline characteristics, were used to match 1,990 pairs of patients with and without hypertension. Matched Cox regression models were used to estimate associations between hypertension and outcomes during a mean of 16 months of follow-up. Heart failure (HF) hospitalization occurred in 11.9% and 8.8% of patients, respectively, with and without hypertension (hazard ratio [HR] for hypertension vs no hypertension 1.36, 95% confidence interval [CI] 1.10 to 1.68, p = 0.004). The association between a history of hypertension and HF hospitalization was significant only in patients without previous HF (n = 3,495, HR 1.48, 95% CI 1.18 to 1.84, p = 0.001), but not in those with previous HF (n = 485, HR 1.09, 95% CI 0.73 to 1.62, p = 0.688, p for interaction = 0.179). A history of hypertension was not associated with all-cause mortality (HR 1.02, 95% CI 0.86 to 1.22, p = 0.790) or cardiovascular hospitalization (HR 1.08, 95% CI 0.92 to 1.27, p = 0.339). In conclusion, a history of hypertension was associated with subsequent HF hospitalization after acute myocardial infarction, especially in patients without histories of HF, suggesting that hypertension increased the risk for hospitalization with incident HF but did not affect hospitalization for worsening HF symptoms in those with prevalent HF.
Treatment of Hypertension in the Patient with Cardiovascular Disease
2007, Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease
Aggressive lowering of blood pressure
2006, Lancet
Influence of antecedent of hypertension in patients with acute coronary syndrome without ST elevation
2006, Medicina Clinica
Son pocos los estudios que evalúan el efecto del antecedente de hipertensión arterial en el pronóstico a medio-largo plazo tras un síndrome coronario utilizando las nuevas definiciones e incorporando los nuevos marcadores de riesgo en el análisis. El objetivo de nuestro estudio es determinar si hay diferencias entre los pacientes hipertensos y no hipertensos en cuanto al perfil epidemiológico, la forma de presentación, el tratamiento al alta y el pronóstico en los pacientes que ingresan en un hospital por un síndrome coronario agudo sin elevación del segmento ST.
Se estudió a 1.029 pacientes consecutivos ingresados por síndrome coronario agudo sin elevación del segmento ST. Se determinaron las variables pronósticas durante el ingreso (epidemiológicas y bioquímicas), así como el tratamiento administrado al alta. Se siguió la evolución de los pacientes durante un año y el parámetro de valoración principal fue la mortalidad por todas las causas.
El 65,8% (n = 677) de los pacientes eran hipertensos. Estos pacientes presentaron un perfil epidemiológico y bioquímico más desfavorable, así como diferencias en cuanto al tratamiento al alta. Durante el primer año de seguimiento fallecieron 139 pacientes (13,5%). La mortalidad a un año fue del 12,5% en los no hipertensos y del 14,6% en los hipertensos (p = NS). En el análisis de regresión múltiple la hipertensión no mantuvo la significación estadística para la mortalidad.
El antecedente de hipertensión arterial es un factor importante en el desarrollo de un síndrome coronario agudo sin elevación del ST, ya que explica diferencias en cuanto a la presencia de otros factores de riesgo o al tratamiento, pero no se comporta como factor predictor de mortalidad.
There are few studies evaluating the effect of a previous history of hypertension on long term prognosis after an acute coronary syndrome, using the new definitions and incorporating new risk markers in the analysis. The aim of our study was to determinate if hypertensive patients differ from non-hypertensives in the epidemiological profile, clinical presentation, treatment prescribed at discharge and prognosis after admission with non ST segment elevation acute coronary syndrome.
A total of 1,029 consecutive patients admitted with high suspiction of non ST segment elevation acute coronary syndrome were evaluated. Prognostic variables were determined during admission (epidemiological and biochemical), as it was the discharge treatment. The primary endpoint was defined as all cause mortality at one year follow up.
65.8% (n = 677) of patients had hypertension. Hypertensive patients displayed a worst epidemiological and biochemical profile, and different discharge treatment. There were 139 (13.5%) deaths at one year follow up. The all cause mortality for non-hypertensive patients was 12.5% and for hypertensives 14.6% (p = NS). In the multivariate analysis (Cox regression) there were no differences in mortality between these groups.
A previous history of hypertension is an important factor to explain differences in the presence of other risk factors or the treatment, but is not a mortality predictor.
Coronary Atherosclerotic Sequelae of Hypertension
2005, Hypertension: A Companion to Brenner and Rector's The Kidney
Coronary Atherosclerotic Sequelae of Hypertension
2005, Hypertension

View all citing articles on Scopus

^☆: This study was supported in part by Contracts NIH-N01-HV-92922 and NIH-N01-HV-52971, National Institutes of Health, Bethesda, Maryland.

View full text

EpidemiologyBlood pressure and survival after myocardial infarction: The Framingham study☆

Abstract

J Chronic Dis

Am J Cardiol

Am J Med

Lancet

Am J Cardiol

J Chronic Dis

Am J Cardiol

Survival after myocardial infarction: prognosis and management

Mod Concepts Cardiovasc Dis

Analysis of survival data under the proportional hazards model

Int Stat Rev

Prognostic value of various clinical and electrocardiographic features of acute myocardial infarction: immediate prognosis

Arch Intern Med

Prognosis of patients surviving first clinically diagnosed myocardial infarction

Arch Intern Med

Immediate mortality and five-year survival of employed men with a first myocardial infarction

N Engl J Med

Prognosis of men after first myocardial infarction: mortality and first recurrence in relation to selected parameters

Am J Public Health

Epidemiology
Blood pressure and survival after myocardial infarction: The Framingham study☆