(Circulation. 1995;92:2437-2445.)
© 1995 American Heart Association, Inc.
Articles |
Blood Pressure and Mortality Among Men With Prior Myocardial Infarction
From the Hypertension Division (J.M.F.), Bowman Gray School of Medicine, Winston-Salem, NC; Division of Biostatistics (J.N.), School of Public Health, and Division of Cardiology (R.G.), School of Medicine, University of Minnesota (Minneapolis); Division of Epidemiology and Clinical Applications (J.S., J.C.), National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Md; Section of General Medicine (K.E.), University of Minnesota (Minneapolis), Minneapolis VA Medical Center; and Department of Medicine (S.M.), Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand.
Background The purpose of the present study was to describe the relation between blood pressure (systolic [SBP] and diastolic [DBP]) and death from coronary heart disease (CHD) and all causes for men with a history of myocardial infarction (MI).
Methods and Results The study cohort consisted of men aged
35 to 57 years screened for the Multiple Risk Factor Intervention Trial
(MRFIT) in 1973 through 1975 and followed for survival for an average
of 16 years through 1990. There were 5362 men who reported prior
hospitalization for a heart attack of at least 2 weeks' duration at
the initial screening of MRFIT. There was a J-shaped relation between
SBP and DBP with both CHD and all-cause mortality during the first
2 years of follow-up in older (age, 45 to 57 years) men only. Risk
nadirs for SBP were 152 and 145 mm Hg, respectively, for CHD death and
all-cause mortality; corresponding DBP risk nadirs were 94 and 90
mm Hg. After the first 2 years, there was a positive association
between SBP and death from CHD and all causes. By 15 years, cumulative
CHD mortality percentages for men with screening SBP <120, 120 to 139,
140 to 159, and 
160 mm Hg were 19.7%, 21.3%, 27.5%, and 32.0%,
respectively. When deaths only after year 2 were considered, although
the linear DBP coefficient was significant, the quadratic term for DBP
was no longer significant (P>.05). However, the relation
still appeared J-shaped as cumulative mortality for those with DBP
<70, 70 to 79, 80 to 89, 90 to 99, and 100 mm Hg was 24.3%, 20.8%,
21.1%, 25.5%, and 29.7%, respectively. When the joint relation of
SBP and DBP was considered, there were no survival differences among
the four cohorts (SBP 140 and DBP <80, SBP 140 and DBP 80, SBP
140 and DBP <80, and SBP 140 and DBP 80) during the first 2
years. After 2 years, both CHD and all-cause mortality rates were
approximately 40% higher for participants with SBP 140 mm Hg versus
<140 mm Hg regardless of DBP level (<80 or 80 mm Hg).
Conclusions In this large cohort of men with prior MI, the association of SBP and DBP with CHD and all-cause mortality varied over the 16-year follow-up period. During early follow-up, in older men only, J- or U-shaped relations were evident. However, after 2 years, these same relations had become positive and graded. Given the substantial excess mortality risk in this cohort associated with high blood pressure, particularly SBP, efforts to gradually lower blood pressure should receive high priority among hypertensive men with prior MI.
Key Words: blood pressure • myocardial infarction • heart diseases • mortality
This article has been cited by other articles:
 |
|
 |
|
  C. M.M. Licht, E. J.C. de Geus, A. Seldenrijk, H. P.J. van Hout, F. G. Zitman, R. van Dyck, and B. W.J.H. Penninx Depression Is Associated With Decreased Blood Pressure, but Antidepressant Use Increases the Risk for Hypertension Hypertension, April 1, 2009; 53(4): 631 - 638. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Kjeldsen, T. A. Aksnes, R. H. Fagard, and G. Mancia CHAPTER 13 Hypertension ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Thune, J. Signorovitch, L. Kober, E. J. Velazquez, J. J.V. McMurray, R. M. Califf, A. P. Maggioni, J. L. Rouleau, J. Howlett, S. Zelenkofske, et al. Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction Hypertension, January 1, 2008; 51(1): 48 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Ganotakis, I. F. Gazi, J. A. Papadakis, I. A. Jagroop, D. R. Nair, and D. P. Mikhailidis The Relationship Between Circulating Fibrinogen and Lipoprotein (a) Levels in Patients With Primary Dyslipidemia Clinical and Applied Thrombosis/Hemostasis, January 1, 2007; 13(1): 35 - 42. [Abstract] [PDF]
|
|
|
|
 |
|
 H. A. Liszka, A. G. Mainous III, D. E. King, C. J. Everett, and B. M. Egan Prehypertension and Cardiovascular Morbidity Ann. Fam. Med, July 1, 2005; 3(4): 294 - 299. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Papadakis, D. P. Mikhailidis, G. E. Vrentzos, A. Kalikaki, I. Kazakou, and E. S. Ganotakis Effect of Antihypertensive Treatment on PlasmaFibrinogen and Serum HDL Levelsin Patients with Essential Hypertension Clinical and Applied Thrombosis/Hemostasis, April 1, 2005; 11(2): 139 - 146. [Abstract] [PDF]
|
|
|
|
|
|
M. Kikuya, T. Ohkubo, K. Asayama, H. Metoki, T. Obara, S. Saito, J. Hashimoto, K. Totsune, H. Hoshi, H. Satoh, et al. Ambulatory Blood Pressure and 10-Year Risk of Cardiovascular and Noncardiovascular Mortality: The Ohasama Study Hypertension, February 1, 2005; 45(2): 240 - 245. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Mason, J. E. Manson, H. D. Sesso, C. M. Albert, M. J. Chown, N. R. Cook, P. Greenland, P. M Ridker, and R. J. Glynn Blood Pressure and Risk of Secondary Cardiovascular Events in Women: The Women's Antioxidant Cardiovascular Study (WACS) Circulation, April 6, 2004; 109(13): 1623 - 1629. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M.M. Lawes, D. A. Bennett, V. L. Feigin, and A. Rodgers Blood Pressure and Stroke: An Overview of Published Reviews Stroke, April 1, 2004; 35(4): 1024 - 1033. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M.M. Lawes, D. A. Bennett, V. L. Feigin, and A. Rodgers Blood Pressure and Stroke: An Overview of Published Reviews Stroke, March 1, 2004; 35(3): 776 - 785. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Havas, E. J. Roccella, and C. Lenfant Reducing the Public Health Burden From Elevated Blood Pressure Levels in the United States by Lowering Intake of Dietary Sodium Am J Public Health, January 1, 2004; 94(1): 19 - 22. [Abstract] [Full Text]
|
|
|
|
 |
|
 PROGRESS Collaborative Group Effects of a perindopril-based blood pressure lowering regimen on cardiac outcomes among patients with cerebrovascular disease Eur. Heart J., March 1, 2003; 24(5): 475 - 484. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Pacific Study Group and B. Neal Effects of the vasopeptidase inhibitor, omapatrilat, in 723 patients with coronary heart disease Journal of Renin-Angiotensin-Aldosterone System, December 1, 2002; 3(4): 270 - 276. [Abstract] [PDF]
|
|
|
|
 |
|
 J Amar, B Chamontin, J Ferrieres, N Danchin, O Grenier, C Cantet, and J-P Cambou Hypertension control at hospital discharge after acute coronary event: influence on cardiovascular prognosis--the PREVENIR study Heart, December 1, 2002; 88(6): 587 - 591. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Bur, H. Herkner, M. Vlcek, C. Woisetschlager, U. Derhaschnig, and M. M. Hirschl Classification of Blood Pressure Levels by Ambulatory Blood Pressure in Hypertension Hypertension, December 1, 2002; 40(6): 817 - 822. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Whelton, J. He, L. J. Appel, J. A. Cutler, S. Havas, T. A. Kotchen, E. J. Roccella, R. Stout, C. Vallbona, M. C. Winston, et al. Primary Prevention of Hypertension: Clinical and Public Health Advisory From the National High Blood Pressure Education Program JAMA, October 16, 2002; 288(15): 1882 - 1888. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Klassen, E. G. Lowrie, D. N. Reddan, E. R. DeLong, J. A. Coladonato, L. A. Szczech, J. M. Lazarus, and W. F. Owen Jr Association Between Pulse Pressure and Mortality in Patients Undergoing Maintenance Hemodialysis JAMA, March 27, 2002; 287(12): 1548 - 1555. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Boutitie, F. Gueyffier, S. Pocock, R. Fagard, J. P. Boissel, and for the INDANA Project Steering Committee J-Shaped Relationship between Blood Pressure and Mortality in Hypertensive Patients: New Insights from a Meta-Analysis of Individual-Patient Data Ann Intern Med, March 19, 2002; 136(6): 438 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Bobrie and J. F Potter The elderly hypertensive population: what lies ahead of us? Journal of Renin-Angiotensin-Aldosterone System, March 1, 2002; 3(1_suppl): S4 - S9. [PDF]
|
|
|
|
 |
|
 N. M. Kaplan What Is Goal Blood Pressure for the Treatment of Hypertension? Arch Intern Med, June 25, 2001; 161(12): 1480 - 1482. [Full Text] [PDF]
|
|
|
|
|
|
Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries. Principal results from EUROASPIRE II Euro Heart Survey Programme Eur. Heart J., April 1, 2001; 22(7): 554 - 572. [Abstract] [PDF]
|
|
|
|
 |
|
 S. MacMahon, N. Sharpe, G. Gamble, A. Clague, C. Ni Mhurchu, T. Clark, H. Hart, J. Scott, H. White, and PART-2 Collaborative Research Group Randomized, placebo-controlled trial of the angiotensin-converting enzyme inhibitor, ramipril, in patients with coronary or other occlusive arterial disease J. Am. Coll. Cardiol., August 1, 2000; 36(2): 438 - 443. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. MacMahon Blood Pressure and the Risk of Cardiovascular Disease N. Engl. J. Med., January 6, 2000; 342(1): 49 - 52. [Full Text]
|
|
|
|
|
|
T. O. Obisesan, C. M. Vargas, and R. F. Gillum Geographic Variation in Stroke Risk in the United States : Region, Urbanization, and Hypertension in the Third National Health and Nutrition Examination Survey Stroke, January 1, 2000; 31(1): 19 - 25. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Sievers, P. H. Bennett, J. Roumain, and R. G. Nelson Effect of Hypertension on Mortality in Pima Indians Circulation, July 6, 1999; 100(1): 33 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Arch Intern Med, November 24, 1997; 157(21): 2413 - 2446. [Abstract] [PDF]
|
|
|
|
|
|
A. W. Haider, L. Chen, M. G. Larson, J. C. Evans, M. H. Chen, and D. Levy Antecedent Hypertension Confers Increased Risk for Adverse Outcomes After Initial Myocardial Infarction Hypertension, November 1, 1997; 30(5): 1020 - 1024. [Abstract] [Full Text]
|
|
|
|
|
|
S. MacMahon, A. Rodgers, B. Neal, and J. Chalmers Blood Pressure Lowering for the Secondary Prevention of Myocardial Infarction and Stroke Hypertension, February 1, 1997; 29(2): 537 - 538. [Full Text]
|
|
|
|
|
|
M. Nishizawa, H. Kumagai, M. Ichikawa, N. Oshima, H. Suzuki, and T. Saruta Improvement in Baroreflex Function by an Oral Angiotensin Receptor Antagonist in Rats With Myocardial Infarction Hypertension, January 1, 1997; 29(1): 458 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Black and J.-Y. Yi A New Classification Scheme for Hypertension Based on Relative and Absolute Risk With Implications for Treatment and Reimbursement Hypertension, November 1, 1996; 28(5): 719 - 724. [Abstract] [Full Text]
|
|
|
|
|
|
C. Lenfant High Blood Pressure: Some Answers, New Questions, Continuing Challenges JAMA, May 22, 1996; 275(20): 1604 - 1606. [Abstract] [PDF]
|
|