Prognostic significance of acute systolic hypertension after myocardial infarction.

Fox, Kim; Tomlinson, I W; Portal, R W; Aber, Clive P.

doi:10.1136/bmj.3.5976.128

Cited by 17 publications

(5 citation statements)

References 17 publications

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“…Furthermore, the timing of the intervention, a minimum of 7 h after hospital admission, would render infarction reduction less probable (Maroko et al, 1978). No (Fox et al, 1975;Rosenbaum & Levine, 1941).…”

Section: Discussionmentioning

confidence: 99%

“…MYOCARDIAL infarction complicated by systemic hypertension has been associated with a higher incidence of left ventricular failure, major arrhythmia and hospital death (Fox et al, 1975;Rosenbaum & Levine, 1941). The improved coronary perfusion resulting from raised systemic BP in this situation probably does not compensate for the increased myocardial oxygen consumption occasioned by elevated afterload, with consequent impairment of myocardial function.…”

Section: Introduction Methodsmentioning

confidence: 99%

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Labetalol infusion in acute myocardial infarction with systemic hypertension.

Marx¹,

Reid²

1979

Brit J Clinical Pharma

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1 Fifteen patients with suspected acute myocardial infarction and systemic BP of greater than 160/110 mmHg were treated with an incremental infusion of labetalol. 2 Systemic BPs were safely and effectively lowered to less than 130 mmHg systolic or 90 mmHg diastolic in all patients. 3 Heart rate, mean pulmonary artery wedge pressure cardiac index and stroke work index were significantly reduced. 4 The dose of labetalol varied from 30 mg-440 mg and was significantly higher (mean 295 mg) in those patients with pre-existing systemic hypertension compared with others (mean 133 mg). 5 No side-effects occurred and all patients survived ito leave hospital.

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Section: Discussionmentioning

confidence: 99%

Section: Introduction Methodsmentioning

confidence: 99%

Labetalol infusion in acute myocardial infarction with systemic hypertension.

Marx¹,

Reid²

1979

Brit J Clinical Pharma

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“…Criteria for inclusion were: (1) acute (less than 48 hours) infarction (that is severe chest pain, appearance of new Q waves and/or abnormal levels of MB Accepted for publication 3 February 1983 creatinine kinase); (2) systemic hypertension (systolic value greater than 150 mmHg) persisting over six hours in spite of adequate sedation and control of chest pain; (3) normal sinus rhythm; and (4) cardiac index greater than 2*4 1/min per M2.…”

Section: Methodsmentioning

confidence: 99%

Treatment of hypertension in acute stage of myocardial infarction. Haemodynamic effects of labetalol.

Renard¹,

Riviere²,

Jacobs³

et al. 1983

Heart

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SUMMARY Labetalol was used to treat systemic hypertension (systolic blood pressure above 150 mmHg) in 11 patients with acute myocardial infarction; its haemodynamic effects and tolerance were studied.Increasing doses of labetalol were infused to lower systolic blood pressure to less than 130 mmHg; the optimal rate was then maintained for one hour (mean rate: 2.3 mg/min). Haemodynamic variables were measured before, during, and after labetalol infusion. Labetalol lowered blood pressure in all patients; this effect was related to a decrease both in total systemic resistance (17.7 to 14 IU) and in cardiac index (3.1 to 2.7 1/min per m2); the stroke index remained unchanged and the heart rate was reduced (94 to 81 beats/min). There was no significant change in the-mean pulmonary wedge pressure; it was decreased, however, in the six patients with an initial pressure greater than 15 mmHg. The double product was-greatly decreased (16 497 to 8598 mmHgx beats per min), which is favourable in acute myocardial infarction.We conclude that labetalol is a drug of choice to treat hypertension in acute myocardial infarction because it is very effective; its haemodynamic effects are likely to reduce myocardial oxygen requirements and suggest that labetalol administration does not worsen moderate left sided heart failure. The drug, however, may reduce the cardiac output.Systemic hypertension is frequent in the acute stage of myocardial infarction' and is associated with a higher incidence of complications.24 Labetalol which combines alpha and beta adrenoceptor blockade seems to be an effective drug in managing this type of hypertension.5 6 This study was designed to evaluate the haemodynamic changes and the clinical response after intravenous administration of labetalol to such patients. Patients and methodsEleven patients were studied (10 men and one woman), all of whom were less than 70 years of age.Criteria for inclusion were: (1) The following variables were calculated according to the usual formulae: cardiac index, stroke index, left ventricular stroke work index, total systemic resistance, and total pulmonary resistance. LABETALOL ADMINISTRATIONBefore the administration of labetalol, two series of stable haemodynamic measurements were obtained at five minute intervals; the mean of the two control observations was used as steady state value.Labetalol was administered intravenously by constant infusion. The infusion solution consisted of 200 mg labetalol in 150 ml 5% glucose in water. The infusion was initiated with a dose of 0-5 mg/min; at intervals of five minutes, labetalol dosage was increased by increments of 0-3 mg/min until the optimal dose for each individual patient was obtained. The dose was considered optimal when the systolic blood pressure was reduced below 130 mmHg. The infusion of labetalol was then given at this optimal dose over a period of 60 minutes. Complete sets ofhaemodynamic measurements were repeated at intervals 15, 30, and 60 minutes from the beginning of infusion at the optimal rate. The labetalo...

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“…35 Acute elevation of blood pressure in the setting of acute myocardial infarction may be transient and not harmful,36 but others have observed that the mortality rate and the incidence of cardiac failure were significantly greater in patients with severe systolic hypertension and acute myocardial infarction. 37 Reduction of systemic arterial pressure early in the course of acute myocardial infarction has been shown to protect the myocardium as reflected by reduced release of creatine phosphokinase (CPK) enzyme activity. 35 Thus, cautious treatment of hypertension in patients with acute myocardial infarction is likely to be beneficial.…”

Section: Severementioning

confidence: 99%

Current concepts in the diagnosis and management of hypertensive urgencies and emergencies.

Ram

1990

Keio j. med

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Hypertensive crises constitute a group of distinct clinico-pathological entities in which rapid control of hypertension is indicated to previous serious complications. Although systemic blood pressure is invariably elevated in these conditions, it is the status of the target organ function which determines the need for urgent reduction of blood pressure. The physicians should be cognizant of the pathophysiological basis of hypertensive crises so that rational therapeutic choices can be made. The chief objective should be to arrest and, if possible, to reverse the target organ damage. Once the diagnosis of hypertensive crisis is evident, the blood pressure should be lowered quickly while paying careful attention to the cardiovascular, neurologic, and renal function. Several potent, parentally effective antihypertensive drugs such as nitroprusside, labetalol, and nicardipine are available to produce an immediate fall in blood pressure. The choice of drug therapy should be made on the basis of the pharmacodynamic and clinical effects, advantages, and disadvantages. Once the emergency situation is resolved, the etiology of hypertensive crisis should be considered. (Keio J Med 39 (4): 225-236, December, 1990)

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Prognostic significance of acute systolic hypertension after myocardial infarction.

Cited by 17 publications

References 17 publications

Labetalol infusion in acute myocardial infarction with systemic hypertension.

Labetalol infusion in acute myocardial infarction with systemic hypertension.

Treatment of hypertension in acute stage of myocardial infarction. Haemodynamic effects of labetalol.

Current concepts in the diagnosis and management of hypertensive urgencies and emergencies.

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