The prognostic significance of a history of systemic hypertension in patients randomised to either placebo or ramipril following acute myocardial infarction: evidence from the AIRE study

Spargias, KS; Ball, Susan; Hall, Alistair S.

doi:10.1038/sj.jhh.1000883

Cited by 19 publications

(8 citation statements)

References 25 publications

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“…This is consistent with findings of several prior analyses indicating that a history of hypertension is a nonsignificant or modest predictor of short-and long-term cardiovascular risk after acute myocardial infarction (27)(28)(29), particularly when patients are well treated (30).…”

Section: Discussionsupporting

confidence: 80%

Relation of Characteristics of Metabolic Syndrome to Short-Term Prognosis and Effects of Intensive Statin Therapy After Acute Coronary Syndrome

et al. 2005

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OBJECTIVE -We examined relations between characteristics of the metabolic syndrome, early cardiovascular risk, and effect of early, intensive statin therapy after acute coronary syndrome. RESEARCH DESIGN AND METHODS -A total of 3,038 patients in the MyocardialIschemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial were characterized by the presence or absence of a history of diabetes, a history of hypertension and/or blood pressure Ն130/Ն85, BMI Ͼ30 kg/m 2 , HDL cholesterol Ͻ40 mg/dl (men) or Ͻ50 mg/dl (women), and triglycerides Ն150 mg/dl. Patients with three or more of these characteristics were categorized as having metabolic syndrome.RESULTS -A total of 38% of patients (n ϭ 1,161) met criteria for metabolic syndrome as defined in this study and had a 19% incidence of a primary end point event (death, nonfatal myocardial infarction, cardiac arrest, or recurrent unstable myocardial ischemia) during the 16-week trial. Patients with two or fewer characteristics (n ϭ 1,877) were classified as not having metabolic syndrome and had a 14% incidence of a primary end point event. In univariate analysis, the individual characteristics that bore a significant relation to risk were diabetes and low HDL cholesterol. In a multivariable model including age, sex, and randomized treatment assignment, presence of metabolic syndrome was associated with a hazard ratio of 1.49 (95% CI 1.24 -1.79, P Ͻ 0.0001). Relative risk reduction with 80 mg atorvastatin daily compared with placebo was similar in patients with and without metabolic syndrome.CONCLUSIONS -Metabolic syndrome, as defined in the context of this clinical trial, is a strong predictor of early recurrent ischemic events after acute coronary syndrome.

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Section: Discussionsupporting

confidence: 80%

Relation of Characteristics of Metabolic Syndrome to Short-Term Prognosis and Effects of Intensive Statin Therapy After Acute Coronary Syndrome

et al. 2005

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“…In accordance with this interpretation, retrospectively collected data from the Acute Infarction Ramipril Efficacy (AIRE) study have demonstrated that a history of hypertension was an independent indicator of poor prognosis in placebo-treated but not in ramipril-treated patients. 18 Post hoc analysis of the Survival of Myocardial Infarction Long-term Evaluation (SMILE) study also demonstrated a highly beneficial effect of ACE inhibitor treatment on patients with a positive history of hypertension. 19 Another possibility is that, in general, hypertensive populations or treatment of these populations is changing.…”

Section: Discussionmentioning

confidence: 99%

Importance of a history of hypertension for the prognosis after acute myocardial infarction‐‐‐for the bucindolol evaluation in acute myocardial infarction trial (BEAT) study group

Ali

Akman

Bruun

et al. 2004

Clinical Cardiology

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SummaryBackground: Arterial hypertension is a major risk factor for cardiovascular events. The prognosis for hypertensive patients after acute myocardial infarction (MI) is uncertain because of the sparse and somewhat contradictionary data.Hypothesis: Our study aimed to investigate the importance of hypertension to prognosis after an MI in patients receiving contemporary medical therapy.Methods: We performed a retrospective study using a large register from the Bucindolol Evaluation in Acute myocardial infarction Trial (BEAT). The register comprised 3,326 patients admitted between June 1998 and August 1999 with an enzyme-verified MI to 33 Danish coronary care units. Hypertension was considered present when a previous diagnosis of hypertension was accompanied by relevant medical therapy. Survival information for all patients was obtained in January 2002.Results: Of the 3,326 patients studied, 825 were hypertensive. Overall, 28.4% had died by January 2002. The unadjusted hazard ratio associated with hypertension was 1.2 (95% confidence limit [CI] 1.1-1.4, p = 0.004). Hypertensive patients were older, and after adjustment for age the hazard ratio

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“…21 Thus, while previous MI and left ventricular dysfunction form the substrates, ischemia and ventricular premature beats provide the triggers for ventricular arrhythmia, which in turn increases the risk of mortality and sudden death after MI. 22 Antecedent hypertension, being a major determinant of ventricular afterload, increases infarct expansion and ventricular hypertrophy; this, in turn, enhances the risk of arrhythmic death further.…”

Section: Mechanistic Link Between Demographic and Clinical Variables mentioning

confidence: 99%

Prognostic impact of demographic factors and clinical features on the mode of death in high-risk patients after myocardial infarction - A combined analysis from multicenter trials

et al. 2005

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SummaryBackground: Contemporary information is lacking on the effect of demographic features and clinical features on the specific mode of mortality after myocardial infarction (MI) in the thrombolytic era.Hypothesis: The aims of this study were (1) to examine the risk and trend of a different mode of mortality (i.e., all-cause, arrhythmic, and nonarrhythmic cardiac mortality) in highrisk patients post MI with reduced left ventricular ejection fraction (LVEF) or ventricular arrhythmias; and (2) to assess the predictive value of demographic and clinical variables in the prediction of specific modes of death in high-risk patients post MI in the thrombolytic era.Methods: In all, 3,431 patients receiving placebo (2,700 men, median age 64 ± 11 years) from the EMIAT, CAMIAT, SWORD, TRACE, and DIAMOND-MI studies, with LVEF < 40% or ventricular arrhythmia were pooled. Risk factors for mortality among patients surviving ≥ 45 days after MI up to 2 years were examined using Cox regression. Short-term survival (from onset of MI to Day 44 after MI) was also examined for TRACE and DIAMOND-MI, in which patients were recruited within 2 weeks of MI.

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The prognostic significance of a history of systemic hypertension in patients randomised to either placebo or ramipril following acute myocardial infarction: evidence from the AIRE study

Cited by 19 publications

References 25 publications

Relation of Characteristics of Metabolic Syndrome to Short-Term Prognosis and Effects of Intensive Statin Therapy After Acute Coronary Syndrome

Relation of Characteristics of Metabolic Syndrome to Short-Term Prognosis and Effects of Intensive Statin Therapy After Acute Coronary Syndrome

Importance of a history of hypertension for the prognosis after acute myocardial infarction‐‐‐for the bucindolol evaluation in acute myocardial infarction trial (BEAT) study group

Prognostic impact of demographic factors and clinical features on the mode of death in high-risk patients after myocardial infarction - A combined analysis from multicenter trials

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