Park Jin Sup, Cha Kwang Soo, Shin Donghun, Lee Dae Sung, Lee Hye Won, Oh Jun-Hyok, Choi Jung Hyun, Lee Han Cheol, Hong Taek Jong, Lee Sang Hyun, Kim Jeong Su, Park Yong Hyun, Kim June Hong, Chun Kook-Jin, Jeong Myung Ho, Ahn Youngkeun, Chae Shung Chull, Kim Young Jo
Department of Cardiology, Pusan National University Hospital, Busan, South Korea;
Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea;
Am J Hypertens. 2015 Jun;28(6):797-805. doi: 10.1093/ajh/hpu230. Epub 2014 Nov 27.
We evaluated the impact of normal vs. high presenting blood pressure (BP) on clinical outcomes and cardiac function in patients with ST-elevation myocardial infarction (MI).
In 11,292 patients, in-hospital mortality and major adverse clinical events (MACE; all-cause death, nonfatal MI, or any revascularization) during follow-up were compared between patients with normal (≥ 100 mm Hg and ≤ 139 mm Hg) and high (≥ 140 mm Hg) systolic BP at presentation.
Compared to patients with high BP, patients with normal BP had significantly higher in-hospital mortality (1.5% vs. 3.7%; P < 0.001), especially in those with prior hypertension, and higher rates of all-cause death (3.3% vs. 5.3%; P < 0.001) and MACE (9.8% vs. 11.8%; P = 0.04) during follow-up (median: 330 days). After multivariate adjustment, normal BP was associated with higher risk of in-hospital mortality (adjusted hazard ratio (HR) = 2.268; 95% confidence interval (CI) = 1.144-4.498; P = 0.019), but not all-cause death (adjusted HR = 0.956; 95% CI = 0.602-1.517) or MACE (adjusted HR = 0.935; 95% CI = 0.755-1.158). Left ventricular ejection fraction at baseline and follow-up was significantly lower in patients with normal BP (52% vs. 51%; P < 0.001 and 55% vs. 54%; P = 0.018, respectively).
Our findings indicate that patients with normal presenting BP, especially those with prior hypertension, exhibit higher in-hospital mortality and poorer cardiac function compared to patients with high BP. Although outcomes during follow-up did not differ, cardiac function was persistently poorer in patients who presented with normal BP.
我们评估了ST段抬高型心肌梗死（MI）患者就诊时血压正常与血压高对临床结局和心脏功能的影响。
在11292例患者中，比较了就诊时收缩压正常（≥100mmHg且≤139mmHg）和收缩压高（≥140mmHg）的患者的院内死亡率以及随访期间的主要不良临床事件（MACE；全因死亡、非致死性MI或任何血运重建）。
与血压高的患者相比，血压正常的患者院内死亡率显著更高（1.5%对3.7%；P<0.001），尤其是有高血压病史的患者，且随访期间（中位数：330天）全因死亡率（3.3%对5.3%；P<0.001）和MACE发生率（9.8%对11.8%；P=0.04）也更高。多因素调整后，血压正常与院内死亡风险较高相关（调整后风险比（HR）=2.268；95%置信区间（CI）=1.144-4.498；P=0.019），但与全因死亡（调整后HR=0.956；95%CI=0.602-1.517）或MACE（调整后HR=0.935；95%CI=0.755-1.158）无关。血压正常的患者基线和随访时的左心室射血分数显著更低（分别为52%对51%；P<0.001和55%对54%；P=0.018）。
我们的研究结果表明，就诊时血压正常的患者，尤其是有高血压病史的患者，与血压高的患者相比，院内死亡率更高，心脏功能更差。虽然随访期间结局无差异，但就诊时血压正常的患者心脏功能持续较差。
