Key result
Omitting beta-blockers and RAASi in low-DBP AMI patients is linked to ~26% higher MACCE risk.
Why the study?
The clinical impact of beta-blockers and renin-angiotensin-aldosterone system inhibitors in acute myocardial infarction patients with low diastolic blood pressure needed evaluation.
Do beta-blockers and RAASi reduce 1-year MACCE in patients with acute myocardial infarction and low diastolic blood pressure?
Cohort (n=11,267)
Yes
Do beta-blockers and RAASi reduce 1-year MACCE in patients with acute myocardial infarction and low diastolic blood pressure?
Answers are grounded in this paper and cite their sources.
In patients with AMI and low discharge DBP, the absence of BB or RAASi therapy is associated with worse clinical outcomes, supporting the continued use of guideline-directed therapies in this population.
Objective: To evaluate the clinical impact of beta-blockers (BB) and renin–angiotensin–aldosterone system inhibitors (RAASi) in patients with acute myocardial infarction (AMI) and low diastolic blood pressure (DBP). Methods: We analyzed a pooled cohort from two nationwide prospective registries (KAMIR-NIH and KAMIR-V) conducted between 2011 and 2020. A total of 11,267 patients with AMI and discharge DBP <70 mmHg were included. The primary endpoint was 1-year major adverse cardiac and cerebrovascular events (MACCE). Multivariable-adjusted Cox regression analyses were performed. Results: At 1 year, MACCE occurred more frequently in patients receiving neither BB nor RAASi compared with those receiving either therapy (15.2% vs. 11.1%). The absence of both therapies was independently associated with a higher risk of MACCE (HR 1.26, 95% CI 1.03–1.54). In the 4-group analysis, MACCE incidence was lowest in the BB+/RAASi+ group (10.3%) and highest in the BB−/RAASi− group (15.2%). Compared with the BB+/RAASi+ group, the risk of MACCE was significantly higher in the BB+/RAASi− group (HR 1.21, 95% CI 1.02–1.44) and BB−/RAASi− group (HR 1.34, 95% CI 1.09–1.64), whereas the BB−/RAASi+ group showed no significant difference (HR 1.19, 95% CI 0.98–1.45).Conclusions: In patients with AMI and low DBP, the absence of BB or RAASi therapy was associated with worse clinical outcomes. These findings support the continued use of guideline-directed therapies even in patients with low DBP.
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kim et al. (2026) conducted a cohort in Acute myocardial infarction with low diastolic blood pressure (n=11,267). Absence of beta-blockers and RAAS inhibitors vs. Receiving either therapy was evaluated on 1-year major adverse cardiac and cerebrovascular events (MACCE) (HR 1.26, 95% CI 1.03-1.54). The absence of beta-blockers and RAASi in AMI patients with low DBP was associated with a higher risk of 1-year MACCE compared to receiving either therapy (HR 1.26; 95% CI 1.03-1.54).
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