Abstract 2594: Post Myocardial Infarction Hypertension and Cardiovascular Outcomes in Patients with Left Ventricular Dysfunction, Heart Failure, or Both Following Acute Myocardial Infarction
Introduction. Hypertension is a risk factor for developing MI and subsequent left ventricular (LV) dysfunction and heart failure (HF). However, the impact of sustained hypertension in patients following an MI is not well known.
Methods. The VALsartan In Acute myocardial iNfarcTion trial (VALIANT) enrolled 14,703 patients with acute MI complicated by HF, LV dysfunction, or both. The effect of post-MI hypertension during follow-up was assessed in 11,025 patients who survived event-free 6 months following randomization. These patients were considered to have post-MI hypertension if they had an average systolic blood pressure of ≥140mm Hg at 1, 3, and 6 months follow-up.
Results. Of event-free 6-month survivors, 2192 (19.9%) had an average visit blood pressure of ≥140 mm Hg. Patients with elevated blood pressure were older, more likely to be female, had higher LVEF, lower peak CK and eGFR, and more diabetes. Elevated blood pressure post-MI was associated with a greater likelihood of all major endpoints, including cardiovascular death, MI, stroke, sudden cardiac arrest, HF hospitalization, and a composite. The risk of MI, stroke, sudden death, or the composite endpoint was significantly increased after adjusting for major covariates (table⇓).
Conclusions. Persistently elevated blood pressure, present in a substantial number of patients post-MI despite optimal therapy with an inhibitor of the renin-angiotensin system, conferred increased risk for future cardiovascular events. Cardiovascular risk associated with sustained increased blood pressure after MI