Impact of hypertension on the outcome of patients admitted with acute coronary syndrome

Erne, Paul; Radovanovic, Dragana; Schoenenberger, Andreas; Bertel, Osmund; Kaeslin, Thomas; Essig, Manfred; Gaspoz, Jean-Michel (2015). Impact of hypertension on the outcome of patients admitted with acute coronary syndrome. Journal of hypertension, 33(4), pp. 860-867. Lippincott Williams & Wilkins 10.1097/HJH.0000000000000343

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OBJECTIVE The role of hypertension and its impact on outcome in patients with acute coronary syndrome (ACS) is still debated. This study aimed to compare the outcomes of hypertensive and nonhypertensive ACS patients. METHODS Using data of ACS patients enrolled in the Acute Myocardial Infarction in Switzerland Plus Registry from 1997 to 2013, characteristics at presentation and outcomes in hospital and after 1 year were analyzed. Hypertension was defined as previously diagnosed and treated by a physician. The primary endpoint was mortality. Data were analyzed using multiple logistic regressions. RESULTS Among 41 771 ACS patients, 16 855 (40.4%) were without and 24 916 (59.6%) with preexisting hypertension. Patients with preexisting hypertension had a more favorable in-hospital outcome [odds ratio (OR) in-hospital mortality 0.82, 95% confidence interval (CI) 0.73-0.93; P = 0.022]. The independent predictors of in-hospital mortality for patients with preexisting hypertension were age, Killip class greater than 2, Charlson Comorbidity Index greater than 1, no pretreatment with statins and lower admission systemic blood pressure. Preexisting hypertension was not an independent predictor of 1-year mortality in the subgroup of patients (n = 7801) followed: OR 1.07, 95% CI 0.78-1.47; P = 0.68. Independent predictors of mortality 1 year after discharge for the 4796 patients with preexisting hypertension were age, male sex and comorbidities. Angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists and statins prescribed at discharge improved the outcomes. CONCLUSION Outcome of ACS patients with preexisting hypertension was associated with an improved in-hospital prognosis after adjustment for their higher baseline risk. However, this effect was not long-lasting and does not necessarily mean a causal relationship exists. Short-term and long-term management of patients with hypertension admitted with ACS could be further improved.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Gastroenterology
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Geriatric Clinic

UniBE Contributor:

Schoenenberger, Andreas and Essig, Manfred

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0263-6352

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Rebecca Rufer

Date Deposited:

29 Mar 2016 16:34

Last Modified:

01 May 2016 02:30

Publisher DOI:

10.1097/HJH.0000000000000343

PubMed ID:

25915891

BORIS DOI:

10.7892/boris.77265

URI:

https://boris.unibe.ch/id/eprint/77265

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