Abstract 16415: Optimal Blood Pressure Target in Patients With Acute Myocardial Infarction
Introduction: Current guidelines for blood pressure (BP) control have not been well standardized in patients with acute myocardial infarction (AMI). They do not suggest BP goal in patients with AMI, and only describe it in patients with coronary heart disease.
Hypothesis: We aimed to analyze optimal systolic and diastolic BP target in patients with AMI.
Methods: We analyzed consecutive 11,745 AMI patients (63.8±13.5 years old, 8,772 males) who survived at hospital discharge. Systolic BP (SBP) and diastolic BP (DBP) were represented as mean value of 3 times visit: hospital discharge, 6-month and 1-year follow-up. Clinical outcomes were analyzed according to 7 different systolic and diastolic BP groups, and adjusted for combined cardiovascular risk factors. 1-year clinical outcome was defined as the composite of 1-year major adverse cardiac events (MACE) including death, recurrent MI, and target vessel revascularization (TVR), CABG, and hospitalization due to heart failure.
Results: Mortality at 1-yr demonstrated J-shaped curve according to SBP and DBP with lowest events at SBP 121-130 mmHg (p for trend=0.002) and at DBP 71-80 mmHg (p for trend=0.006). Incidence of MACEs at 1-yr also demonstrated J-shaped curve according to SBP and DBP with lowest events at SBP 121-130 mmHg (p for trend<0.001) and at DBP 71-80 mmHg (p for trend=0.003). However, incidences of recurrent MI, TVR and CABG were not different among each SBP and DBP groups. Subgroup analysis according to diabetes mellitus revealed same J curves for 1-yr mortality and MACEs regardless of diabetes mellitus. Multivariate analysis demonstrated that only patients with SBP < 130 mmHg and DBP < 80 mmHg had significantly lower risk for 1-yr mortality (SBP: adjusted odds ratio [OR] 0.41, 95% CI 0.18-0.97, p=0.042, DBP: adjusted OR 0.50, 95% CI 0.34-0.73, p<0.001).
Conclusions: Blood pressure control with SBP < 130 mmHg and DBP < 80 mmHg demonstrated most risk reduction for 1-yr clinical outcomes in patients with AMI. Those goals were not changed in AMI patients with and without diabetes mellitus
Author Disclosures: K. Lee: None. H. Park: None. N. Yoon: None. J. Cho: None. J. Kim: None. Y. Ahn: None. M. Jeong: None. J. Park: None.
- © 2016 by American Heart Association, Inc.