The clinical course of acute ST-elevation myocardial infarction in patients with hypertension

Abstract

Background: Arterial hypertension has been documented as one the cardiovascular risk factors. The issue whether hypertension worsens the clinical course and short-term prognosis of patients with acute ST-elevation myocardial infarction (STEMI) has been addressed by several studies, however, the results were not uniform.

Aim: To compare the clinical course and short-term prognosis in STEMI patients with or without hypertension.

Methods: The study group consisted of 366 patients with STEMI, of whom 234 (63.9%) had a history of hypertension (150 males, mean age 58.5+/-11.2 years) whereas 132 (100 males, mean age 60.3+/-11.9) did not. All patients underwent primary angioplasty with stent implantation. Details from medical history, cardiovascular risk factors, clinical course and in-hospital complications were recorded and compared between patients with and without hypertension.

Results: There were differences between both study groups in the prevalence of cardiovascular risk factors. Patients with hypertension had more frequently history of coronary artery disease (56 vs. 37%, p<0.01), BMI>25 kg/m2 (90 vs. 85%, p<0.01), type 2 diabetes (27 vs. 14%, p<0.05), hyperlipidaemia (56 vs. 43%, p<0.05), and renal disease (11 vs. 5%, p<0.05). Clinical course of MI was more complicated in patients with hypertension who had more often cardiogenic shock (10 vs. 6%, p<0.05), pulmonary oedema (12 vs. 4%, p<0.05), sinus tachycardia>90 beats/min on admission (12 vs. 4%, p<0.05), ventricular tachycardia or fibrillation (20 vs. 11%, p<0.01) and complete atrioventricular block (11 vs. 4%, p<0.01). In-hospital deaths occurred in 18 (7.7%) patients with hypertension and 7 (5.3%) patients without hypertension (NS). Multivariate analysis identified age>65 years, symptoms of heart failure, atrial fibrillation, elevated blood glucose level and creatinine level as independent prognostic factors of adverse outcome in both groups whereas history of stroke, increased while cell blood count, urea level and two-vessel disease where independent prognostic variables in patients with hypertension. Ventricular tachycardia or fibrillation had prognostic significance only in STEMI patients without hypertension.

Conclusion: Patients with STEMI and hypertension have more cardiovascular risk factors and more complicated in-hospital course of MI than normotensive patients.