Abstract 2683: Inverse Relationship of Blood Pressure Level to Cardiovascular Mortality and Benefit of the Implantable Cardioverter Defibrillator in Patients with Ischemic Left Ventricular Dysfunction
Introduction: Elevated systolic, diastolic and pulse blood pressures (SBP. DBP, and PP, respectively) are major risk factors for heart failure and cardiovascular mortality. However, data on the relationship between BP indices and the risk of cardiac and sudden cardiac death (SCD) in patients with left ventricular dysfunction are limited.
Methods: The risk of all-cause, cardiac mortality and SCD by BP indices was analyzed in 1231 post-myocardial infarction patients with an ejection fraction ≤30% enrolled in the prospective Multicenter Automatic Defibrillator Implantation Trial-II.
Results: In non-ICD-treated patients, increasing SBP quartiles showed an inverse correlation with cardiovascular mortality (Figure⇓); similar trends were shown for DBP and PP. Multivariate analysis showed that 10 mm Hg increments in SBP were independently associated with a respective 15% (p = 0.01) and 16% (p = 0.04) reduction in the risk of cardiac mortality and SCD. Upper quartiles of SBP (>130 mm Hg) and DBP (≥80 mm Hg) were independently associated with a similar 59% decline in the risk of death as compared with the low BP quartiles (p = 0.004 and 0.005, respectively). Defibrillator therapy provided no evident benefit in the lower-risk upper SBP (HR = 1.04; p = 0.90) and DBP (HR = 1.05; p = 0.88) quartiles, and significant benefit in the high-risk low SBP (HR = 0.61; p = 0.002) and DBP (HR = 0.62; p = 0.002) quartiles.
Conclusions: In patients with ischemic left ventricular dysfunction, BP levels show an inverse association with the risk of cardiac and sudden cardiac death and with ICD efficacy.