Lazzeri Chiara, Valente Serafina, Chiostri Marco, Attanà Paola, Picariello Claudio, Gensini Gian Franco
Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134 Florence, Italy.
Heart Vessels. 2012 Jul;27(4):370-6. doi: 10.1007/s00380-011-0169-6. Epub 2011 Jul 7.
Hypertension is well established as a risk factor for the development of atherosclerosis. Data on the impact of hypertension in patients with ST elevation myocardial infarction are so far inconsistent, and are mainly related to studies performed in the thrombolytic era. We assessed the impact of hypertension over the short and long term in 560 patients with ST elevation myocardial infarction (STEMI) and without previously known diabetes, all of whom were submitted to mechanical revascularization and consecutively admitted to our Intensive Cardiac Care Unit. Hypertensive patients were older (p < 0.001), more frequently male (0.005), and they showed a reduced eGFR (p < 0.001). Smoking was more frequent in nonhypertensive patients (p < 0.001), while the incidence of three-vessel coronary artery disease was higher in hypertensive patients (p = 0.003). No difference in the in-hospital mortality rates for the two subgroups was detected. At follow-up (median 32.5 months, 25th-75th percentile 16.9-47.3 months), Kaplan-Meier survival analysis detected no differences in mortality between hypertensive and nonhypertensive patients (log rank χ(2) 0.38, p = 0.538). According to our data, obtained from a large series of consecutive STEMI patients without previously known diabetes, all of whom were submitted to primary PCI, a history of hypertension does not affect mortality over either the short or the long term. Moreover, hypertensive patients showed an altered glucose response to stress, as indicated by higher admission glucose values, poorer in-hospital glucose control, and a higher incidence of acute insulin resistance (as indicated by the HOMA index). Hypertensive patients therefore appear to warrant careful metabolic management during their hospital courses.
高血压已被确认为动脉粥样硬化发展的一个危险因素。关于高血压对ST段抬高型心肌梗死患者影响的数据目前尚不一致，且主要与溶栓时代进行的研究有关。我们评估了560例ST段抬高型心肌梗死（STEMI）且既往无糖尿病的患者短期和长期的高血压影响，所有患者均接受了机械血运重建并连续入住我们的心脏重症监护病房。高血压患者年龄较大（p<0.001），男性更常见（p = 0.005），且估算肾小球滤过率（eGFR）降低（p<0.001）。非高血压患者吸烟更常见（p<0.001），而高血压患者三支冠状动脉疾病的发生率更高（p = 0.003）。未检测到两个亚组的院内死亡率有差异。在随访中（中位时间32.5个月，第25-75百分位数为16.9-47.3个月），Kaplan-Meier生存分析未发现高血压和非高血压患者在死亡率上有差异（对数秩χ(2) 0.38，p = 0.538）。根据我们从大量连续的既往无糖尿病且均接受了直接经皮冠状动脉介入治疗（PCI）的STEMI患者中获得的数据，高血压病史在短期或长期均不影响死亡率。此外，高血压患者表现出对应激的葡萄糖反应改变，表现为入院血糖值较高、院内血糖控制较差以及急性胰岛素抵抗发生率较高（如通过稳态模型评估（HOMA）指数所示）。因此，高血压患者在住院期间似乎需要仔细的代谢管理。
