Table 2.
Clinical studies showing the prognostic value of admission blood pressure due to acute coronary syndromes
| Study | Patients (N) | Index | Type of ACS | Short‐term prognosis | Long‐term prognosis | Limitations |
|---|---|---|---|---|---|---|
| ACSIS study36 | 7645 | Admission SBP < 110 mm Hg vs admission SBP = 110‐140 mm Hg | ACS (STEMI‐NSTEMI‐UA) |
7‐d all‐cause mortality HR = 2.37, 95% CI: 1.66‐3.38, P < 0.001 MACE at 30 d OR = 1.51, 95% CI: 1.23‐1.86, P < 0.001 |
1‐y all‐cause mortality HR = 1.92, 95% CI: 1.57‐2.35, P < 0.001 |
Observational study Patients with cardiogenic shock were not excluded at entry No adjustment for medication prior to presentation |
| Roth et al37 | 3943 (1786 Hypertensives) | Admission SBP < 120 mm Hg vs admission SBP = 121‐140 mm Hg | ACS (STEMI‐NSTEMI‐UA) | – |
Overall 1‐y mortality adjusted RR = 0.65, 95% CI: 0.54‐0.8, P < 0.01 Cardiovascular mortality adjusted RR = 0.65, 95% CI: 0.47‐0.9, P < 0.01 |
Based on data from a registry Cardiovascular risk factors were analyzed as categorical variables Treatment data were limited to acute care only Patients with cardiogenic shock were not excluded at entry No adjustment for medication prior to presentation |
| Admission DBP < 60 mm Hg vs admission DBP = 61‐80 mm Hg |
Overall 1‐y mortality adjusted RR = 0.45, 95% CI: 0.36‐0.56, P < 0.01 Cardiovascular mortality adjusted RR = 0.33, 95% CI: 0.23‐0.48, P < 0.01 |
|||||
| Lee et al38 | 10 337 (prior hypertension = 6605) | Admission SBP | NSTACS |
Higher in‐hospital mortality among patients with lower SBP: adjusted OR = 1.21 per 10 mm Hg lower, 95% CI: 1.15‐1.27, P < 0.001 No differences between patients with and without hypertension |
Single SBP measurement Potential selection bias (severely sick may have not been enrolled) Potential underdiagnosis or underreporting of prior hypertension Doses of antihypertensive drugs and patient adherence before admission were not recorded |
|
| Park et al39 | 11 292 | Admission SBP = 100‐139 mm Hg vs admission SBP > 140 mm Hg | STEMI patients undergoing PCI | Normal SBP → higher in‐hospital mortality (1.5% vs 3.7%), P < 0.001. Adjusted HR = 2.268, 95% CI: 1.144‐4.498, P < 0.019 | No differences at 1‐y follow‐up |
Observational study Incidence and effect of right ventricular infarction were not evaluated Lack of information regarding antihypertensive drugs Lack of follow‐up BP levels |
| Ma et al40 | 7033 |
Admission SBP > 140 mm Hg vs SBP < 110 mm Hg |
STEMI |
30‐d all‐cause mortality HR = 0.70, 95% CI :0.55‐0.87, P = 0.003 |
Retrospective observational analysis Not all patients received reperfusion therapy Small sample size on PCI group |
|
| DBP > 90 mm Hg vs DBP < 70 mm Hg | No difference | |||||
| PP > 60 mm Hg vs PP < 40 mm Hg | HR = 0.60, 95% CI :0.47‐0.75, P < 0.001) | |||||
| MAP > 106.7 mm Hg vs MAP < 83.3 mm Hg | No difference |
Abbreviations: ACS, acute coronary syndrome; DBP, diastolic blood pressure; MACE, major adverse cardiac events; MAP, mean arterial pressure; NSTACS, non–ST‐elevation acute coronary syndromes; NSTEMI, non–ST‐elevation myocardial infarction; PCI, percutaneous coronary intervention; PP, pulse pressure; SBP, systolic blood pressure; STEMI, ST‐elevation myocardial infarction; UA, unstable angina.