HIGH BLOOD PRESSURE AT ADMISSION TO THE INTENSIVE CARE UNIT FOR CHEST PAIN CONFERS A LOW LONG-TERM TOTAL MORTALITY: PP.15.68

Abstract

Objective: Little is known about the relationship between BP under acute stress, such as in acute chest pain, and subsequent mortality. We studied the long term mortality related to supine blood pressure in patients admitted to the intensive care unit for acute chest pain. Design and Methods: Data from the RIKS-HIA registry (Registry of Information and Knowledge about Swedish Heart Intensive care Admissions) was used to analyze the total mortality in relation to supine admission systolic BP in 119151 subjects that were treated at the intensive care unit for the symptom of chest pain 1997–2007, i.e. the study was prospective and observational with hard endpoints. Results were presented according to systolic BP quartiles (Q) Q1: <128 mmHg, Q2: 128–144 mmHg, Q3: 145–162 mmHg, and Q4: ≥163 mmHg. Results: Mean follow up time was 2.47 ± 1.5 years (range 1–10 years). One-year mortality-rate by Cox proportional-hazard corrected for gender, smoking, and age showed that subjects in Q4 had the best prognosis (hazard-ratio 0.368, 95% CI: 0.348–0.389, of Q1 compared with Q4). The relatively poor prognosis in Q1 was independent of the amount of antihypertensive medications, body-mass-index, total-cholesterol, treatment with statin at discharge, main previous diagnoses, and diastolic BP levels. The results were similar after exclusion of patients with congestive heart failure and analogous in the sub group of 21197 patients with known diabetes at admission. Also, one-year mortality-rate by Cox proportional-hazard corrected for gender smoking, and age showed that subjects with a systolic BP >180 mmHg had lower risk than those within the interval 140–160 mmHg (hazard-ratio 0.738, 95% CI: 0.686–0.794). Conclusions: The favourable prognosis with a high admission BP in acute chest pain raises new questions on the relationship between acute stress, BP and mortality. The addition of the level of admission BP in the risk evaluation in acute chest pain can clearly be beneficial, albeit with the message that higher is better.