The impact of blood pressure variability (BPV) on cardiovascular morbidity and mortality has been examined through the prism of heart failure and hypertension, but not in the setting of myocardial infarction (MI). The aim of this study is to determine the association between in-hospital short-term BPV and long-term cardiovascular outcomes in MI patients.
A total population of 130 patients [82.2% male; mean age: 63.8 years; 71.3% hypertensives, 47.3% STEMI] underwent 24-h ambulatory BP measurement during hospitalization for MI. At one year a follow-up was scheduled in order to assess major cardiovascular outcomes. These included cardiovascular death, hospitalization for heart failure (HF), stroke, acute coronary syndrome (ACS), ventricular tachycardia, atrial fibrillation. The parameters of BPV analyzed were: a) 24-h standard deviation (SD), b) the coefficient of variation (CV) and c) the average real variability (ARV) of systolic and diastolic BP.
Cardiovascular death was independently predicted by SD SBP [(HR, 2.406; CI, 0.207–4.604 (P = 0.032)] and CV SBP [(HR, 3.093; CI, 1.295–4.892 (P = 0.001)] in the entire population and separately in STEMI group [(HR, 5.674; CI, 2.214–9.135 (P = 0.002) and (HR, 5.669; CI, 2.499–8.838 (P = 0.001) respectively]. Regarding overall hospitalizations for cardiovascular events, ARV SBP and ARV DBP demonstrated a significant predictive role in the entire population [(HR, 1.045; CI, 0.327–1.762 (P = 0.005) and (HR, 0.991; CI, 0.342–1.640 (P = 0.003) respectively] and the STEMI group [(HR, 1.161; CI, 0.227–2.095 (P = 0.016) and (HR, 0.964; CI, 0.033–1.896 (P = 0.043) respectively]. For NSTEMI group only ARV DBP was a predictor for overall hospitalizations [(HR, 1.043; CI, 0.116–1.970 (P = 0.028)]. Independency of all predictors was confirmed in multivariate models including gender, age, hypertension, DM, smoking, low density lipoprotein (LDL-C) and GFR.
In the setting of MI, in-hospital BPV was associated with cardiovascular morbidity and mortality during the one-year follow-up. These findings could suggest clinical need for further individualization of BP regulation in the integrative ACS management.
First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, GREECE