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(Hypertension. 2008;51:26.)
© 2008 American Heart Association, Inc.

Editorial Commentaries

Blood Pressure Targets After High-Risk Myocardial Infarction

Is It Time to Update the Guidelines?

Scott J. Denardo; R. David Anderson; Carl J. Pepine

From the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville.

Correspondence to Scott J. Denardo, Division of Cardiovascular Medicine, University of Florida College of Medicine, 1600 SW Archer Rd/Box 100277, Gainesville, FL 32610-0277. E-mail scott.denardo@medicine.ufl.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In this issue of Hypertension, Thune et al¹ analyze data from the Valsartan in Acute Myocardial Infarction Trial to assess the effect of antecedent hypertension and post-myocardial infarction (MI) blood pressure (BP) on adverse cardiovascular outcomes. Their results for acute MI patients with antecedent hypertension support previous reports of increased risk for adverse cardiovascular outcomes. In addition, their results for all of the post-MI patients, regardless of antecedent hypertension status, with excessively high or low systolic BP (extrapolating their 3 BP categories, essentially a "V"-shaped plot), are consistent with a majority of reports focusing on hypertension management for post-MI patients (essentially "J"- or "U"-shaped curves). Finally, their results for post-MI excessively high or low diastolic BP reportedly deviated in a similar manner but not significantly. The lack of a significant deviation was ascribed by the authors to an inadequate number of patients for analysis (602; representing 5.7% of the total cohort).

Those patients with excessively high or low diastolic BP represent a small but significant subpopulation of the patients that we see with acute MI (larger than that reported by Thune et al,¹ because patients selected for the Valsartan in Acute Myocardial Infarction Trial excluded those with systolic BP <100 mm Hg). Most studies of hypertension management in coronary artery disease patients do suggest a "J"- or "U"-shaped relationship between adverse outcome and diastolic BP. The mechanism accounting for increased adverse events with high diastolic BP has been hypothesized to involve a combination of multiple direct physiological effects, including . . . [Full Text of this Article]

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Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction

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Hypertension 2008 51: 48-54. [Abstract] [Full Text] [PDF]

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