Short-term Prognostic Importance Of Ambulatory Pulse Pressure and Other Bood Pressure Parameteres In Patients With Acute ST Elevation Myocardial Infarction

Year 2020, Volume: 6 Issue: 2, 74 - 89, 30.06.2020

İhsan Dursun Ozcan Yilmaz

Abstract

Purpose: It is known that high blood pressure increased cardiovascular mortality and affected the prognosis in patients with acute myocardial infarction (AMI). However the blood pressure parameter which is more important and the ideal level of blood pressure have not been known yet.In this study we aimed to investigate affect of early phase ambulatory pulse pressure and other blood pressure levels one month cardiovascular end points.
Materials and Methods:119 patients with first ST elevation AMI included in this study. Ambulatory blood pressures were measured in first 48 hour after admission. Left ventricular ejection fraction and wall motion score index (WMSI) were measured by echocardiography within 72 hour of admission. One month later cardiovascular end points were recorded by phone call.
Results: One month mortality, reinfarction and recurrent angina rate were found as 6%, 3% and 16%, respectively. Advanced age, increased WMSI and lack of use of beta blockers were related with cardiovascular end points ( p <0.005, p<0.05, p<0.05, respectively). The relationship between blood pressure indexes and 1 month cardiac end points could not be found. This relationship also could not be found after adjustment with age, WMSI and beta blocker use in multivariate analysis. In patients with recurrent angina; mean diastolic blood pressure was found as 66±7 mmHg and those without recurrent angina it was 71±8 mmHg ( p<0.05) . Relative risk for recurrent angina in patients with diastolic blood pressure less than 70 mmHg was found as 2,4 ( 95% CI: 0.92-4.23).
Conclusion: In this study ambulatory blood pressure parameters were not significantly different between patients with or without cardiovascular events. But low diastolic blood pressure levels were related with recurrent angina.

Keywords

acute myocardial infarction, blood pressure, pulse pressure, cardiovascular mortality

ST-Elevasyonlu Akut Miyokard İnfarktüslü Hastalarda Ambulatuar Nabız Basıncı ve Diğer Kan Basıncı Parametrelerinin Erken Dönem Prognostik Önemi

Abstract

Amaç: Yüksek kan basıncının kardiyovasküler mortaliteyi artırdığı ve akut miyokard infarktüslü (AMI) olgularda prognozu etkilediği bilinmektedir. Ancak hangi kan basıncı parametresinin ne kadar önemli olduğu ve infarktüslü olgularda ideal kan basıncı düzeyinin ne olduğu iyi bilinmemektedir. Çalışmamızda AMI’lı olgularda erken dönem ambulatuar nabız basıncı ve diğer kan basıncı düzeylerinin bir aylık kardiyovasküler son noktalar üzerine etkisinin olup olmadığını araştırmayı amaçladık.
Materyal ve metod: Çalışmamıza ilk kez ST segment elevasyonlu AMI geçiren toplam 119 hasta alındı. Hastalara yatışlarının ilk 48 saati içinde kan basıncı ölçümü için ambulatuar tansiyon aleti takıldı. Tüm hastalara yatışlarının ilk 72 saati içinde ekokardiyografi yapılarak ejeksiyon fraksiyonu ve duvar hareket skor indeksi (WMSI) hesaplandı. Hastalar 1 ay sonra telefon ile aranarak kardiyovasküler son noktalar( ölüm, reenfarkt, rekürren anjina) kaydedildi.
Bulgular: Hastaların 1 aylık mortalite oranı %6, reinfarktüs oranı %3 ve rekürren anjina oranı %16 olarak bulundu. İleri yaş, artmış WMSI ve beta-bloker kullanmamak majör kardiyak son noktalar ile ilişkili bulunmuştur (sırasıyla p<0,005, p<0,05, p<0,05). Kan basıncı indeksleri ile 1 aylık kardiyak son noktalar arasında ilişki bulunamamıştır. Bu ilişki multivariate analizinde yaş, WMSI ve beta-bloker kullanımına göre düzeltildikten sonra bile izlenmemiştir. Ancak rekürren anjina gelişenlerde ortalama diastolik kan basıncı (DKB) 66 ±7 mmHg, gelişmeyenlerde 71±8 mmHg olarak bulunmuştur (p<0,05). DKB’ nin 70 mmHg altında olması ile rekürren anjina için rölatif risk 2,4 (%95 CI: 0,92-4,23) olarak bulunmuştur.
Sonuç: Çalışmamızda ambulatuar kan basıncı parametreleri kardiyovasküler olay gelişen ve gelişmeyen hastalarda farklı olmamakla birlikte düşük diyastolik kan basınçları rekürren anjina ile ile ilişkili bulunmuştur.

Keywords

Akut myokard enfarktüsü, kan basıncı, nabız basıncı, kardiyovasküler mortalite

References

• Crawford MH, DiMarco JP (ed). Cardiology. Philadelphia: Mosby, 2001.
• Buyukozturk K, Gultekin N, Deligonul U, et al. Acute systolic hypertension after acute myocardial infarction: Prognostic and therapeutic significance. Acta Cardiol 1980;35:341-347.
• Herlitz J, Karlson BW, Richter A, Wiklund O, Jablonskiene D, Hjalmarson A. Prognosis in hypertensives with acute myocardial infarction. J Hypertens 1992;10:1265-1271. https://doi.org/10.1097/00004872-199210000-00022
• Njolstad I, Arnesen E. Preinfarction blood pressure and smoking are determinants for a fatal outcome of myocardial infarction: A prospective analysis from the Finnmark Study. Arch Intern Med 1998 Jun 22;158:1326-1332 https://doi.org/10.1001/archinte.158.12.1326
• Wong CK, White HD. Relation between blood pressure after an acute coronary event and subsequent cardiovascular risk. Heart 2002;88:555-558. https://doi.org/10.1136/heart.88.6.555.
• Franklin SS, Larson MG, Khan SA, et al. Does the relation of blood pressure to coronary heart disease change with aging? Circulation 2001;103:1245-1249. https://doi.org/10.1161/01.cir.103.9.1245
• Kannel WB, Gordon T, Schwartz MJ. Systolic versus diastolic blood pressure and risk of coronary heart disease. Am J Cardiol 1971;27:335–346. https://doi.org/10.1016/0002-9149(71)90428-0
• Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in nonhypertensive participants in the Framingham Heart Study: A cohort study. Lancet 2001;358:1682-1686. https://doi.org/10.1016/S0140-6736(01)06710-1
• Somes GW, Pahor M, Shorr RI, Cushman WC, Applegate WB. The role of diastolic blood pressure when treating isolated systolic hypertension. Arch Intern Med 1999;159:2004-2009. https://doi.org/10.1001/archinte.159.17.2004
• Samuelsson OG, Wilhelmsen LW, Pennert KM, Wedel H, Berglund GL. The J-shaped relation between coronary heart disease and achieved blood pressure level in treated hypertension. J Hypertens 1990;8:547-555. https://doi.org/10.1097/00004872-199006000-00008
• Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantification of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358-367. https://doi.org/10.1016/s0894-7317(89)80014-8
• Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure: Hypertension 2003;42:1206-1252. https://doi.org/10.1161/01.HYP.0000107251.49515.c2
• Domanski M, Mitchell G, Pfeffer M, et al. Pulse pressure and cardiovascular disease-related mortality: Follow-up study of the multiple risk factor intervention trial (MRFIT). JAMA 2002;287:2677-2683. https://doi.org/10.1001/jama.287.20.2677
• Khattar R, Swales J. Pulse pressure and prognosis. Heart 2001;85:484-486. https://doi.org/10.1136/heart.85.5.484
• Aylward PE, Wilcox RG, Horgan JH, et al. Relation of increased arterial blood pressure to mortality and stroke in the context of contemporary thrombolytic therapy for acute myocardial infarction. A randomized trial. GUSTO-I Investigators. Ann Intern Med 1996;125:891-900. https://doi.org/10.7326/0003-4819-125-11-199612010-00004
• Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998;351:1755-1762. https://doi.org/10.1016/s0140-6736(98)04311-6
• Hansson L. The Hypertension Optimal Treatment study and the importance of lowering blood pressure. J Hypertens Suppl 1999;17:S9-13.
• Madhavan S, Ooi WL, Cohen H, Alderman MH. Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction. Hypertension 1994;23:395-401. https://doi.org/10.1161/01.hyp.23.3.395
• Benetos A, Safar M, Rudnichi A, et al. Pulse pressure: A predictor of long-term cardiovascular mortality in a French male population. Hypertension 1997;30:1410-1415. https://doi.org/10.1161/01.hyp.30. 6.1410
• Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation 2003;107:2864-2869. https://doi.org/10.1161/01.CIR.0000069826.36125.B4
• Clement DL, De Buyzere ML, De Bacquer DA, et al. Office versus ambulatory pressure study investigators. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 2003;348:2407-2415. https://doi.org/10.1056/NEJMoa022273