Hypertension and patients with acute coronary syndrome: Putting blood pressure levels into perspective

Abstract

Arterial hypertension is a well‐established cardiovascular risk factor, and blood pressure (BP) control has largely improved the prognosis of hypertensive patients. A number of studies have assessed the role of BP levels in the prognosis of patients with acute coronary syndromes. Pathophysiologic links of hypertension to acute myocardial infarction (MI) include endothelial dysfunction, autonomic nervous system dysregulation, impaired vasoreactivity, and a genetic substrate. A history of hypertension is highly prevalent among patients presenting with MI, and some, but not all, studies have associated it with a worse prognosis. Some data support that low levels of admission and in‐hospital BP may indicate an increased risk for subsequent events. Risk scores used in patients with MI have, therefore, included BP levels and a history of hypertension in their variables. Of note, good long‐term BP control, ideally initiated prior to discharge, should be pursued in order to improve secondary prevention.

Blood pressure levels for patients with acute coronary syndromes

“…In the paper by Konstantinou and associates, 1 I congratulate the authors for the excellent description of the underlying pathophysiology and agree with their speculation that a systolic blood pressure of higher than 110 mm Hg and a diastolic blood pressure lower than 70 mm Hg prior to discharge are associated with better long-term prognosis. This is in agreement with the findings of the randomized trial, Systolic Blood Pressure Intervention Trial that was carried out in persons at an increased cardiovascular risk.…”

“…In the paper by Konstantinou and associates, the authors restate the importance of hypertension as a cause of cardiovascular disease and the effect of this condition on the prognosis of patients with acute coronary syndromes. They describe the pathophysiologic links of hypertension to acute myocardial infarction including endothelial dysfunction, autonomic nervous system dysregulation, impaired vasoreactivity, and a genetic substrate.…”

Hypertension Awareness, Treatment, and Control in Mexico: An Opportunistic Medical Student-led Blood Pressure Screening Campaign – A Cross-sectional Study

“…On the contrary, evidence suggests that prompt, long-term BP control is imperative to improve secondary prevention of MI. 24 Thus, further studies are needed to explore this topic specifically in the Mexican population.…”

Association between admission systolic blood pressure and major adverse cardiovascular events in patients with acute myocardial infarction

“…In addition, using data from more than 10,000 non-ST-elevation ACS patients in two large registries, Lee et al found an independent relationship between lower SBP and in-hospital mortality; hypertension history or use of antihypertensive medication did not affect these associations [14]. Nevertheless, only a few studies have examined whether admission SBP levels per se might affect hard outcomes in AMI patients [18]. Previous studies have been limited to the association between higher admission SBP and better outcome, so that the specific relationship between admission SBP and adverse outcome is not clearly clarified.…”