Table 1.
Clinical studies examining the prognostic value of a history of HTN in patients with ACS
| Study | Patients (N) | Short‐term prognosis | Long‐term prognosis |
|---|---|---|---|
| Studies supporting an unfavorable association | |||
| GISSI‐2 Investigators23 | 10 712 with MI treated with thrombolysis (3306 history of treated HTN) | Patients with HTN had a significantly higher in‐hospital mortality, left ventricular failure, and recurrent ischemic events | Patients with HTN had a significantly higher mortality, left ventricular failure, and recurrent ischemic events after 6 mo of follow‐up |
| Dumaine et al24 | 15 414 with ACS (10 998 history of HTN) | HTN was associated with the composite end point of death/MI at 30 d (OR = 1.61, 95% CI: 1.30‐1.99, P < 0.001), 30‐d mortality (OR = 1.72, 95% CI: 1.21‐2.42, P < 0.001), MI (OR = 1.61, 95% CI: 1.25‐2.06, P < 0.001), recurrent ischemia (OR = 1.26, 95% CI: 1.10‐1.44, P < 0.001), and major bleeding (OR = 1.45, 95% CI: 1.03‐2.06, P = 0.036) | HTN was associated with the composite end point of death/MI at 1 y (OR = 1.54, 95% CI: 1.31‐1.81, P < 0.001), mortality (OR = 1.70, 95% CI: 1.34‐2.16, P < 0.001), MI (OR = 1.50, 95% CI: 1.23‐1.82, P < 0.001), and recurrent ischemia (OR = 1.24, 95% CI: 1.11‐1.38, P < 0.001) |
| Lingman et al25 | 2329 with ACS (974 hypertensives and 446 diabetic) undergoing revascularization | HTN was weakly associated with impaired long‐term prognosis (HR = 1.18, 95% CI: 1.02‐1.37, P = 0.02) compared with DM, but the combination was even additive (HR = 2.10, 95% CI: 1.71‐2.57, P < 0.001) | |
| De Luca et al26 | 6298 STEMI patients (2764 with HTN) undergoing primary angioplasty | HTN was associated with impaired postprocedural TIMI 0‐2 flow (adjusted OR = 1.22, 95% CI: 1.01‐1.47, P = 0.034) | HTN was associated with higher mortality (adjusted HR = 1.24, 95% CI: 1.01‐1.54, P = 0.048) and reinfarction (adjusted HR = 1.31, 95% CI: 1.03‐1.66, P = 0.027) |
| Studies showing a favorable or non‐significant association | |||
| De Luca et al27 | 830 STEMI patients (362 with HTN) undergoing primary PCI | HTN did not affect the rate of postprocedural TIMI 3 flow and infarct size [12.5% (4.1%‐23.8%) vs 12.8% (4.3%‐24.7%), P = 0.38]. Similar results were observed in subanalyses in major high‐risk subgroups | |
| Majahalme et al22 | 979 ACS patient (630 with HTN) | No differences in rehospitalization (adjusted OR = 1.3, 95% CI: 0.9‐1.9, P = 0.12) and the composite of death, rehospitalization for cardiac reasons, MI, and stroke at 6 mo (OR = 1.2, 95% CI: 0.9‐1.7, P = 0.19) | |
| Lazzeri et al28 | 560 STEMI patients (300 with HTN) undergoing primary PCI | No difference in in‐hospital mortality rates | No differences in mortality after a median of 32.5‐mo follow‐up (log rank χ 2 = 0.38, P = 0.538) |
| Cecchi et al29 | 1031 STEMI patients (551 with HTN) and 437 non‐STEMI patients (322 with HTN) undergoing PCI | HTN was not associated with in‐hospital mortality in either group | HTN was not associated with long‐term mortality in either group after a mean of 40.2‐mo follow‐up |
| Abrignani et al30 | 1830 first MI patients (915 with HTN) from a data of 4994 MI patients | Hypertensive patients less frequently presented with cardiogenic shock (4.0% vs 11.6%, P < 0 0.01), atrioventricular block (4.9% vs 7.4%, P = 0.02), ventricular fibrillation (2.2% vs 3.7%, P = 0.04), and cardiac rupture (0.1% vs 0.9%, P = 0.02) | Mortality was higher in normotensives than in hypertensives (17.8% v 6.2%, P < 0.001), regardless of infarction site |
| Erne et al31 | 41 771 ACS patients (24 916 with HTN) | HTN associated with a more favorable in‐hospital prognosis (OR = 0.82, 95% CI: 0.73‐0.93, P = 0.022) | HTN was not an independent predictor of 1‐y mortality in a subgroup of 7801 patients followed (OR = 1.07, 95% CI: 0.78‐1.47, P = 0.68) |
Abbreviations: ACS, acute coronary syndrome; DM, diabetes mellitus; HTN, hypertension; MI, acute myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST‐elevation myocardial infarction.