Abstract 1059: Achieving Longitudinal Target Blood Pressure After Acute Myocardial Infarction
Background: Blood pressure (BP) control is a Class I guideline recommendation after acute myocardial infarction (AMI), yet uncontrolled hypertension remains prevalent in the post-AMI population. An understanding of the factors associated with longitudinal BP control is needed to target medication and behavioral interventions.
Methods: A total of 562 AMI patients in the TRIUMPH Registry had a history of hypertension or elevated BPs during their index hospitalization and follow-up BPs measured at 6 months after hospital discharge. Target BPs were defined by JNC7 recommendations: <130/80 for patients with diabetes or chronic kidney disease and <140/90 for all others. We compared clinical, demographic, and psychosocial variables between patients at and not at BP target at 6 months.
Results: After AMI, 34% of patients with baseline hypertension failed to achieve target BPs at 6 months. Median BPs at 6 months were 120/70 in the at-target group vs. 140/82 (p<0.001) in the not-at-target group. Differences in demographic, clinical, and baseline psychosocial variables between patients at and not at BP target are described in the Table⇓. Compared with patients at BP target, those with uncontrolled BPs were more frequently non-white, female, single, and underinsured. Patients with uncontrolled BPs were also more likely to be diabetic, have more severe depressive symptoms, and have lower baseline functional status. These patients were also less likely to be follow medication instructions very carefully at 1 month follow-up evaluations (83 v. 92%, p=0.03).
Conclusions: A significant proportion of patients still do not reach BP targets 6 months after AMI, with demographic and psychosocial risk factors accounting for some of the variation in BP control. These variables need to be factored into therapy intensification and medication adherence education efforts such that post-AMI BP control can be optimized.