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(Hypertension. 2008;52:271.)
© 2008 American Heart Association, Inc.

Original Articles

History of Hypertension and Eplerenone in Patients With Acute Myocardial Infarction Complicated by Heart Failure

Bertram Pitt; Ali Ahmed; Thomas E. Love; Henry Krum; Jose Nicolau; José S. Cardoso; Alexander Parkhomenko; Michael Aschermann; Ramon Corbalán; Henry Solomon; Harry Shi; Faiez Zannad

From the University of Michigan Health System (B.P.), Ann Arbor; School of Medicine (A.A.), University of Alabama at Birmingham, and Veterans Affairs Medical Center, Birmingham, Ala; School of Medicine, Case Western Reserve University (T.E.L.), Cleveland, Ohio; Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Prahan, Australia; Heart Institute (InCOR) (J.N.), University of São Paulo Medical School, São Paulo, Brazil; Departamento de Engenharia Electrotécnica e de Computadores (J.S.C.), Faculdade de Engenharia, Universidade do Porto, Porto, Portugal; Emergency Cardiology Department (A.P.), National Institute of Cardiology, Kiev, Ukraine; Interni Klinika (M.A.), Cardiovascular Center, Prague, Czech Republic; Departamento de Enfermedades Cardiovasculares (R.C.), Hospital Clínico y Facultad de Medicina, Pontifica Universidad Catolica de Chile, Santiago, Chile; Pfizer Inc (H. Solomon, H. Shi), New York, NY; and the Clinical Investigation Center (F.Z.), INSERM-CHU de Nancy Hopital Jeanne d'Arc, Dommartin-les Toul, France.

Correspondence to Bertram Pitt, University of Michigan, 1500 E Medical Center Dr, 3910 Taubman Center, Ann Arbor, MI 48109-0366. E-mail bpitt{at}med.umich.edu

In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (n=6632), eplerenone-associated reduction in all-cause mortality was significantly greater in those with a history of hypertension (Hx-HTN). There were 4007 patients with Hx-HTN (eplerenone: n=1983) and 2625 patients without Hx-HTN (eplerenone: n=1336). Propensity scores for eplerenone use, separately calculated for patients with and without Hx-HTN, were used to assemble matched cohorts of 1838 and 1176 pairs of patients. In patients with Hx-HTN, all-cause mortality occurred in 18% of patients treated with placebo (rate, 1430/10 000 person-years) and 14% of patients treated with eplerenone (rate, 1058/10 000 person-years) during 2350 and 2457 years of follow-up, respectively (hazard ratio [HR]: 0.71; 95% CI: 0.59 to 0.85; P<0.0001). Composite end point of cardiovascular hospitalization or cardiovascular mortality occurred in 33% of placebo-treated patients (3029/10 000 person-years) and 28% of eplerenone-treated patients (2438/10 000 person-years) with Hx-HTN (HR: 0.82; 95% CI: 0.72 to 0.94; P=0.003). In patients without Hx-HTN, eplerenone reduced heart failure hospitalization (HR: 73; 95% CI: 0.55 to 0.97; P=0.028) but had no effect on mortality (HR: 0.91; 95% CI: 0.72 to 1.15; P=0.435) or on the composite end point (HR: 0.91; 95% CI: 0.76 to 1.10; P=0.331). Eplerenone should, therefore, be prescribed to all of the post–acute myocardial infarction patients with reduced left ventricular ejection fraction and heart failure regardless of Hx-HTN.

Key Words: eplerenone • hypertension • myocardial infarction • heart failure • morbidity • mortality

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Hypertension 2008 52: 207-208. [Extract] [Full Text] [PDF]

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