MPS 09-05 OPTIMAL BLOOD PRESSURE LEVELS AFTER AN ACUTE MYOCARDIAL INFARCTION - IS LOW ARTERIAL BLOOD PRESSURE AFTER AN ACUTE MYOCARDIAL INFARCTION HARMFUL?

Abstract

Objective: Angiotensin converting enzyme inhibitors (ACEI) and beta-blockers (BB) are recommended after an acute myocardial infarction (AMI). These drugs attenuate myocardial remodeling and lower blood pressure. We pretended to assess the influence of blood pressure on readmission and mortality rate at 1-year post AMI. Design and Method: Prospective study involving 240 patients admitted to the Cardiology department due to an AMI, from the 1st January 2011 to the 30th November 2012. The basal clinical characteristics were noted and ambulatory blood pressure monitoring (ABPM) was made 1-month after the AMI. The follow-up at 1-year was made through phone call. The statistical analysis was undertaken using SPSS. Results: ABPM was performed in 240 patients, 175 men (73%). 49% had ST-segment elevation AMI. At discharge, 74% were on BB, 75% on ACEI, 6% on ARB, 10% on CCB and 22% on diuretics. In ABPM, 27% showed mean arterial systolic pressure (MASP) > 130 mmHg and 18% had MASP < 110 mmHg. 14% had mean arterial diastolic pressure (MADP) > 80 mmHg and 60% had MADP < 60 mmHg. 81% were “dippers”. There were a total of 32 patients readmitted, 24 of which due to cardiovascular (CV) causes. Nocturnal systolic pressure (NSP) > 120 mmHg (p < 0.01), nocturnal diastolic pressure (NDP) > 65 mmHg (p < 0.05), MASP > 130 mmHg (p < 0.05), MADP > 80 mmHg (p < 0.05) and a non-dipper profile (p < 0.01) were all associated with readmission due to CV causes. There were no differences in readmission or mortality among patients with diurnal SP < 110 mmHg or NSP < 100 mmhg. The only independent predictor of readmission due to CV causes was NSP > 120 mmHg. There were a total of 4 deaths (1.7%) without any correlation to ABPM data. Conclusions: In our study, hospital readmission due to CV causes was associated with elevated blood pressure values as well as a non-dipper profile. Low blood pressure appeared to be safe. High NSP was an independent predictor of readmission rate and this parameter should be taken into special account on ABPM after an AMI.