Importance of a History of Hypertension for Survivors of Myocardial Infarction

High blood pressure is a well recognized precursor and risk factor for the development of atherosclerosis and, thus, the clinical conditions of hypertension and coronary disease often co-exist. During the acute phase of a myocardial infarction, the variable extent of myocyte necrosis results in a wide spectrum of ventricular dysfunction. In animal models, as in man, arterial pressure levels tend to fall in relation to the degree of myocardial damage and dysfunction. It is therefore not surprising that in survivors of myocardial infarction, arterial pressure levels no longer portend the same prognosis as in populations without a myocardial infarction. However, there is a consistent theme among the studies of post infarct patients that even a history of previous hypertension connotes a higher risk for adverse cardiovascular events. This presentation will focus on the 837 patients with a history of hypertension, a cohort that was 38% of the 2231 participants in the SAVE study, and will relate their outcome to that of the patients randomized with similar degrees of left ventricular dysfunction but no prior history of hypertension. The presence of even a past history of hypertension was associated with a greater risk for subsequent adverse cardiovascular events and underscores that these individuals maintain pathophysiologic mechanisms which contribute to cardiovascular decompensation even in the absence of continued overt elevations of blood pressure.