Dr Vivek Baliga – What is the optimum blood pressure target in patients with acute myocardial infarction

Article by Dr Vivek Baliga

Recently, a paper was presented at the American Heart Association scientific Sessions in New Orleans that discussed optimal blood pressure target in patients in acute myocardial infarction.

The aim of the study was to analyse what the optimal systolic and diastolic BP targets must be in patients who suffer from an acute MI.

The study analysed 11,745 patients with a mean age of 63.8+/-13.5 years who survived at hospital discharge. Both systolic and diastolic blood pressures were checked over three visits. Hospital discharge blood pressure, and six-month blood pressure and one year follow blood pressure was recorded and the mean value was used in the study. Seven different systolic and diastolic BP groups were analysed and clinical outcomes were determined based on this. Final outcomes are adjusted for combined cardiovascular risk factors.

As is the case with any clinical cardiovascular study, the 1 year clinical outcome included a composite of major adverse cardiac events (MACE) that included death, target vessel revascularisation, recurrent myocardial infarction, coronary artery bypass grafting and hospitalisation due to heart failure.

Results

Mortality was the lowest when systolic blood pressure range between 121 – 130 mmHg and diastolic blood pressure between 71 – 80 mmHg. Similar results were seen with respect to incidence of major adverse cardiovascular events.

However, the differences were seen in incidents are recurrent myocardial infarction, target vessel revascularisation or coronary artery bypass grafting. Individuals with diabetes had encouraging results as well.

Conclusion

From the study, it was found that those individuals who have a systolic blood pressure less than 130 and diastolic blood pressure less than 80 mmHg had the best risk reduction had one year following an acute myocardial infarction. The goals were no different in those with or without diabetes mellitus.

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