Blood pressure levels for patients with acute coronary syndromes

In the paper by Konstantinou and associates,1 the authors restate the importance of hypertension as a cause of cardiovascular disease and the effect of this condition on the prognosis of patients with acute coronary syndromes. They describe the pathophysiologic links of hypertension to acute myocardial infarction including endothelial dysfunction, autonomic nervous system dysregulation, impaired vasoreactivity, and a genetic substrate. They conclude that low levels of admission and inhospital blood pressure may indicate an increased risk for subsequent events. With respect to history of hypertension, four of the cited studies (23‐26 in reference 1) reported an unfavorable effect of hypertension on outcome while six reported a favorable or nonsignificant effect (22, 27‐31 in reference 1). With respect to the effect of admission blood pressure on the outcome, three indicated an unfavorable effect (36, 38, 39 in reference 1) while two (37, 40 in reference 1) showed a favorable effect. Overall, the effect on history of hypertension and of blood pressure on admission is mixed. I understand that the variability of the studies included in this structured review did not allow for formal meta‐analysis.

I congratulate the authors for the excellent description of the underlying pathophysiology and agree with their speculation that a systolic blood pressure of higher than 110 mm Hg and a diastolic blood pressure lower than 70 mm Hg prior to discharge are associated with better long‐term prognosis. This is in agreement with the findings of the randomized trial, Systolic Blood Pressure Intervention Trial that was carried out in persons at an increased cardiovascular risk.2, 3

CONFLICT OF INTEREST

The author has no conflict of interest to disclose.