High pulse pressure and low mean arterial pressure: two predictors of death after a myocardial infarction
OBJECTIVESAlthough the negative prognostic implication of a clinical history of arterial hypertension in myocardial infarction (MI) survivors is well known, the predictive role of the blood pressure (BP) regimen after MI is not well defined. The aim of this study was to investigate the prognostic si...
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| Veröffentlicht in: | Journal of hypertension 2006-12, Vol.24 (12), p.2377-2385 |
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| creator | Avanzini, Fausto Alli, Claudio Boccanelli, Alessandro Chieffo, Carmine Franzosi, Maria G Geraci, Enrico Maggioni, Aldo P Marfisi, Rosa M Nicolosi, Gian L Schweiger, Carlo Tavazzi, Luigi Tognoni, Gianni Valagussa, Franco Marchioli, Roberto |
| description | OBJECTIVESAlthough the negative prognostic implication of a clinical history of arterial hypertension in myocardial infarction (MI) survivors is well known, the predictive role of the blood pressure (BP) regimen after MI is not well defined. The aim of this study was to investigate the prognostic significance of different BP indices in post-MI.
METHODS AND RESULTSWe evaluated the relationship between baseline systolic, diastolic, pulse and mean arterial pressure (MAP), measured by sphygmomanometry at discharge from hospital or within 3 months of an MI, and total and cardiovascular mortality in 11 116 patients enrolled in the GISSI-Prevenzione trial. Over 3.5 years of follow-up, 999 patients died, 657 of them from cardiovascular causes. Low mean and high pulse pressure were significantly associated with total and cardiovascular mortality after controlling for potential confounders in the multivariate analysis. As compared with patients with less extreme BP values, patients with MAP of 80 mmHg or less (n = 1241; 11.2%) had a 48% higher risk of cardiovascular death [95% confidenceinterval (CI) 1.16–1.87; P = 0.001] and those with pulse pressure greater than 60 mmHg (n = 958; 8.6%) had a 35% higher risk (95% CI 1.09–1.69; P = 0.007); only four subjects (0.04%) had both a high pulse pressure and a low MAP (relative risk of cardiovascular death 3.48; 95% CI 0.48–25.88; P = 0.218).
CONCLUSIONSOur results show for the first time an additional prognostic importance of two easily measurable components of BP, definitely high pulse pressure (> 60 mmHg) and low MAP (≤ 80 mmHg), in a large sample of non-selected patients surviving MI who entered a modern programme of cardiovascular prevention. |
| doi_str_mv | 10.1097/01.hjh.0000251897.40002.bf |
| format | Article |
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METHODS AND RESULTSWe evaluated the relationship between baseline systolic, diastolic, pulse and mean arterial pressure (MAP), measured by sphygmomanometry at discharge from hospital or within 3 months of an MI, and total and cardiovascular mortality in 11 116 patients enrolled in the GISSI-Prevenzione trial. Over 3.5 years of follow-up, 999 patients died, 657 of them from cardiovascular causes. Low mean and high pulse pressure were significantly associated with total and cardiovascular mortality after controlling for potential confounders in the multivariate analysis. As compared with patients with less extreme BP values, patients with MAP of 80 mmHg or less (n = 1241; 11.2%) had a 48% higher risk of cardiovascular death [95% confidenceinterval (CI) 1.16–1.87; P = 0.001] and those with pulse pressure greater than 60 mmHg (n = 958; 8.6%) had a 35% higher risk (95% CI 1.09–1.69; P = 0.007); only four subjects (0.04%) had both a high pulse pressure and a low MAP (relative risk of cardiovascular death 3.48; 95% CI 0.48–25.88; P = 0.218).
CONCLUSIONSOur results show for the first time an additional prognostic importance of two easily measurable components of BP, definitely high pulse pressure (> 60 mmHg) and low MAP (≤ 80 mmHg), in a large sample of non-selected patients surviving MI who entered a modern programme of cardiovascular prevention.</description><identifier>ISSN: 0263-6352</identifier><identifier>EISSN: 1473-5598</identifier><identifier>DOI: 10.1097/01.hjh.0000251897.40002.bf</identifier><identifier>PMID: 17082719</identifier><identifier>CODEN: JOHYD3</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure - physiology ; Cardiology. Vascular system ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Coronary heart disease ; Female ; Heart ; Humans ; Hypertension - physiopathology ; Hypotension - physiopathology ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - diagnosis ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Prognosis ; Risk Factors</subject><ispartof>Journal of hypertension, 2006-12, Vol.24 (12), p.2377-2385</ispartof><rights>2006 Lippincott Williams & Wilkins, Inc.</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4581-b180a106edc54134471727c58d55778a1645d8f1850f5d6b02ac929f5783f1953</citedby><cites>FETCH-LOGICAL-c4581-b180a106edc54134471727c58d55778a1645d8f1850f5d6b02ac929f5783f1953</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18285002$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17082719$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Avanzini, Fausto</creatorcontrib><creatorcontrib>Alli, Claudio</creatorcontrib><creatorcontrib>Boccanelli, Alessandro</creatorcontrib><creatorcontrib>Chieffo, Carmine</creatorcontrib><creatorcontrib>Franzosi, Maria G</creatorcontrib><creatorcontrib>Geraci, Enrico</creatorcontrib><creatorcontrib>Maggioni, Aldo P</creatorcontrib><creatorcontrib>Marfisi, Rosa M</creatorcontrib><creatorcontrib>Nicolosi, Gian L</creatorcontrib><creatorcontrib>Schweiger, Carlo</creatorcontrib><creatorcontrib>Tavazzi, Luigi</creatorcontrib><creatorcontrib>Tognoni, Gianni</creatorcontrib><creatorcontrib>Valagussa, Franco</creatorcontrib><creatorcontrib>Marchioli, Roberto</creatorcontrib><creatorcontrib>GISSI-Prevenzione investigators</creatorcontrib><title>High pulse pressure and low mean arterial pressure: two predictors of death after a myocardial infarction</title><title>Journal of hypertension</title><addtitle>J Hypertens</addtitle><description>OBJECTIVESAlthough the negative prognostic implication of a clinical history of arterial hypertension in myocardial infarction (MI) survivors is well known, the predictive role of the blood pressure (BP) regimen after MI is not well defined. The aim of this study was to investigate the prognostic significance of different BP indices in post-MI.
METHODS AND RESULTSWe evaluated the relationship between baseline systolic, diastolic, pulse and mean arterial pressure (MAP), measured by sphygmomanometry at discharge from hospital or within 3 months of an MI, and total and cardiovascular mortality in 11 116 patients enrolled in the GISSI-Prevenzione trial. Over 3.5 years of follow-up, 999 patients died, 657 of them from cardiovascular causes. Low mean and high pulse pressure were significantly associated with total and cardiovascular mortality after controlling for potential confounders in the multivariate analysis. As compared with patients with less extreme BP values, patients with MAP of 80 mmHg or less (n = 1241; 11.2%) had a 48% higher risk of cardiovascular death [95% confidenceinterval (CI) 1.16–1.87; P = 0.001] and those with pulse pressure greater than 60 mmHg (n = 958; 8.6%) had a 35% higher risk (95% CI 1.09–1.69; P = 0.007); only four subjects (0.04%) had both a high pulse pressure and a low MAP (relative risk of cardiovascular death 3.48; 95% CI 0.48–25.88; P = 0.218).
CONCLUSIONSOur results show for the first time an additional prognostic importance of two easily measurable components of BP, definitely high pulse pressure (> 60 mmHg) and low MAP (≤ 80 mmHg), in a large sample of non-selected patients surviving MI who entered a modern programme of cardiovascular prevention.</description><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure - physiology</subject><subject>Cardiology. Vascular system</subject><subject>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</subject><subject>Coronary heart disease</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>Hypertension - physiopathology</subject><subject>Hypotension - physiopathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Prognosis</subject><subject>Risk Factors</subject><issn>0263-6352</issn><issn>1473-5598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkF2P1CAUhonRuLOrf8EQE71r5VAodO_MRl2TTbzRa3LKh-3alhHaTPbfyziTHRI4EJ7DGx5C3gOrgXXqE4N6eBxqVgaXoDtVi-O27sMLsgOhmkrKTr8kO8bbpmobya_Idc6PBSpw85pcgWKaK-h2ZLwffw90v03Z033yOW_JU1wcneKBzh4Ximn1acTp-fqWrod4PLnRrjFlGgN1HteBYigoRTo_RYvJHZvGJWCy6xiXN-RVwBLz9lxvyK-vX37e3VcPP759v_v8UFkhNVQ9aIbAWu-sFNAIoUBxZaV2UiqlEVohnQ6gJQvStT3jaDveBal0E6CTzQ35eHp3n-LfzefVzGO2fppw8XHLptXApGyhgLcn0KaYc_LB7NM4Y3oywMxRtGFgimhzEW3-izZ9KM3vzilbP3t3aT2bLcCHM4DZ4hQSLnbMF07z8gPGCydO3CFOxV7-M20Hn8zgcVpP0UIrXnHGWigLq8oEaP4BiwuXWQ</recordid><startdate>200612</startdate><enddate>200612</enddate><creator>Avanzini, Fausto</creator><creator>Alli, Claudio</creator><creator>Boccanelli, Alessandro</creator><creator>Chieffo, Carmine</creator><creator>Franzosi, Maria G</creator><creator>Geraci, Enrico</creator><creator>Maggioni, Aldo P</creator><creator>Marfisi, Rosa M</creator><creator>Nicolosi, Gian L</creator><creator>Schweiger, Carlo</creator><creator>Tavazzi, Luigi</creator><creator>Tognoni, Gianni</creator><creator>Valagussa, Franco</creator><creator>Marchioli, Roberto</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200612</creationdate><title>High pulse pressure and low mean arterial pressure: two predictors of death after a myocardial infarction</title><author>Avanzini, Fausto ; Alli, Claudio ; Boccanelli, Alessandro ; Chieffo, Carmine ; Franzosi, Maria G ; Geraci, Enrico ; Maggioni, Aldo P ; Marfisi, Rosa M ; Nicolosi, Gian L ; Schweiger, Carlo ; Tavazzi, Luigi ; Tognoni, Gianni ; Valagussa, Franco ; Marchioli, Roberto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4581-b180a106edc54134471727c58d55778a1645d8f1850f5d6b02ac929f5783f1953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Pressure - physiology</topic><topic>Cardiology. Vascular system</topic><topic>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</topic><topic>Coronary heart disease</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>Hypertension - physiopathology</topic><topic>Hypotension - physiopathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Prognosis</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Avanzini, Fausto</creatorcontrib><creatorcontrib>Alli, Claudio</creatorcontrib><creatorcontrib>Boccanelli, Alessandro</creatorcontrib><creatorcontrib>Chieffo, Carmine</creatorcontrib><creatorcontrib>Franzosi, Maria G</creatorcontrib><creatorcontrib>Geraci, Enrico</creatorcontrib><creatorcontrib>Maggioni, Aldo P</creatorcontrib><creatorcontrib>Marfisi, Rosa M</creatorcontrib><creatorcontrib>Nicolosi, Gian L</creatorcontrib><creatorcontrib>Schweiger, Carlo</creatorcontrib><creatorcontrib>Tavazzi, Luigi</creatorcontrib><creatorcontrib>Tognoni, Gianni</creatorcontrib><creatorcontrib>Valagussa, Franco</creatorcontrib><creatorcontrib>Marchioli, Roberto</creatorcontrib><creatorcontrib>GISSI-Prevenzione investigators</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of hypertension</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Avanzini, Fausto</au><au>Alli, Claudio</au><au>Boccanelli, Alessandro</au><au>Chieffo, Carmine</au><au>Franzosi, Maria G</au><au>Geraci, Enrico</au><au>Maggioni, Aldo P</au><au>Marfisi, Rosa M</au><au>Nicolosi, Gian L</au><au>Schweiger, Carlo</au><au>Tavazzi, Luigi</au><au>Tognoni, Gianni</au><au>Valagussa, Franco</au><au>Marchioli, Roberto</au><aucorp>GISSI-Prevenzione investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High pulse pressure and low mean arterial pressure: two predictors of death after a myocardial infarction</atitle><jtitle>Journal of hypertension</jtitle><addtitle>J Hypertens</addtitle><date>2006-12</date><risdate>2006</risdate><volume>24</volume><issue>12</issue><spage>2377</spage><epage>2385</epage><pages>2377-2385</pages><issn>0263-6352</issn><eissn>1473-5598</eissn><coden>JOHYD3</coden><abstract>OBJECTIVESAlthough the negative prognostic implication of a clinical history of arterial hypertension in myocardial infarction (MI) survivors is well known, the predictive role of the blood pressure (BP) regimen after MI is not well defined. The aim of this study was to investigate the prognostic significance of different BP indices in post-MI.
METHODS AND RESULTSWe evaluated the relationship between baseline systolic, diastolic, pulse and mean arterial pressure (MAP), measured by sphygmomanometry at discharge from hospital or within 3 months of an MI, and total and cardiovascular mortality in 11 116 patients enrolled in the GISSI-Prevenzione trial. Over 3.5 years of follow-up, 999 patients died, 657 of them from cardiovascular causes. Low mean and high pulse pressure were significantly associated with total and cardiovascular mortality after controlling for potential confounders in the multivariate analysis. As compared with patients with less extreme BP values, patients with MAP of 80 mmHg or less (n = 1241; 11.2%) had a 48% higher risk of cardiovascular death [95% confidenceinterval (CI) 1.16–1.87; P = 0.001] and those with pulse pressure greater than 60 mmHg (n = 958; 8.6%) had a 35% higher risk (95% CI 1.09–1.69; P = 0.007); only four subjects (0.04%) had both a high pulse pressure and a low MAP (relative risk of cardiovascular death 3.48; 95% CI 0.48–25.88; P = 0.218).
CONCLUSIONSOur results show for the first time an additional prognostic importance of two easily measurable components of BP, definitely high pulse pressure (> 60 mmHg) and low MAP (≤ 80 mmHg), in a large sample of non-selected patients surviving MI who entered a modern programme of cardiovascular prevention.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>17082719</pmid><doi>10.1097/01.hjh.0000251897.40002.bf</doi><tpages>9</tpages></addata></record> |
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| subjects | Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Blood Pressure - physiology Cardiology. Vascular system Clinical manifestations. Epidemiology. Investigative techniques. Etiology Coronary heart disease Female Heart Humans Hypertension - physiopathology Hypotension - physiopathology Male Medical sciences Middle Aged Myocardial Infarction - diagnosis Myocardial Infarction - mortality Myocardial Infarction - physiopathology Prognosis Risk Factors |
| title | High pulse pressure and low mean arterial pressure: two predictors of death after a myocardial infarction |
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