Blood pressure target achievement and antihypertensive medication use in women and men after first-ever myocardial infarction: the Tromsø Study 1994–2016

Q: What are the key findings of this study?

Women achieved post-MI blood pressure targets (<140/90 mm Hg) in 35% vs 52% of men in 1994-2008 (P=0.046) and 50% vs 54% in 2007-2016 (P=0.68).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: First-ever myocardial infarction (n=527). Intervention: Female sex (post-MI secondary prevention) vs. Male sex (post-MI secondary prevention). Primary outcome: Achievement of blood pressure treatment targets (<140/90 mm Hg, or <130/80 mm Hg if diabetic) after first-ever myocardial infarction in Cohort I (p=0.046).

Q: What does this research mean for the field?

Achievement of post-myocardial infarction blood pressure targets is suboptimal overall, with women achieving targets significantly less often than men in earlier cohorts (35% vs 52%) but narrowing in later years (50% vs 54%). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Laila Arnesdatter Hopstock; Anne Elise Eggen; Maja‐Lisa Løchen; Ellisiv B. Mathiesen; Amalie Nilsen Hagen; Inger Njølstad; Tom Wilsgaard

doi:10.1136/openhrt-2017-000746

January 1, 2018Open HeartOpen Access

Blood pressure target achievement and antihypertensive medication use in women and men after first-ever myocardial infarction: the Tromsø Study 1994–2016

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Key result

Female sex linked to ~17 percentage points lower post-MI blood pressure target achievement in earlier cohort.

P=0.046
n=527

Why the study?

Does blood pressure treatment target achievement and antihypertensive medication use after first-ever myocardial infarction differ between women and men across two time periods in a Norwegian population?

Key Points

To assess sex-specific changes in blood pressure, antihypertensive drug use, and blood pressure target achievement following a first-ever myocardial infarction across two time periods.
Followed participants from the population-based Tromsø Study across two periods: MI-cohort I (N=10 089, 1994–1995 to 2007–2008) and MI-cohort II (N=8412, 2007–2008 to 2015–2016).
Identified participants with first-ever myocardial infarction (n=396 in cohort I; n=131 in cohort II) and evaluated attainment of blood pressure targets (<140/90 mm Hg, or <130/80 mm Hg if diabetic).
Applied linear regression models to analyze age-adjusted and sex-specific changes in systolic and diastolic blood pressure.
Blood pressure targets were achieved by 35% of women versus 52% of men in cohort I (age-adjusted P=0.046), and by 50% of women versus 54% of men in cohort II (age-adjusted P=0.68).
Antihypertensive drug use was reported by 88% of women and 87% of men in cohort I, compared to 76% of women and 81% of men in cohort II at the follow-up screenings.
Age-adjusted systolic blood pressure changed by 0.4 mm Hg (95% CI −3.7 to 4.5) in women versus −4.1 mm Hg (95% CI −7.0 to −1.3) in men in cohort I, and decreased by −7.9 mm Hg (95% CI −15.5 to −0.4) in women versus −13.0 mm Hg (95% CI −18.3 to −7.7) in men in cohort II.

Study Design

Type

Cohort (n=527)

Multicenter

No

Structured PICO

Does blood pressure treatment target achievement and antihypertensive medication use after first-ever myocardial infarction differ between women and men across two time periods in a Norwegian population?

P

Population

527 Norwegian adults with a first-ever myocardial infarction across two longitudinal population-based cohorts (396 in 1994-2008 and 131 in 2007-2016), approximately 33% female, followed between consecutive Tromsø Study waves.

E

Exposure

Female sex and post-MI secondary prevention / antihypertensive medication use in routine clinical practice

C

Comparator

Male sex and post-MI secondary prevention / antihypertensive medication use in routine clinical practice

O

Outcome

Achievement of blood pressure treatment targets (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes) and change in systolic and diastolic blood pressure from pre-MI baseline to post-MI follow-up screening (2007-2008 for Cohort I; 2015-2016 for Cohort II)surrogate

Main Result

Absolute Event Rate: 34.9% vs 51.7%

p-value: p=0.046

Despite high rates of antihypertensive medication use (76%-88%), roughly half of post-MI patients in Norway fail to achieve blood pressure targets, highlighting the need for improved secondary prevention strategies in both women and men.

Limitations

Low follow-up attendance among surviving MI patients (only 44% in Tromsø 6 and 55% in Tromsø 7 attended the second screening)
Selection/survival bias towards more favourable blood pressure levels because non-attendees were older, more likely to be smokers, and had higher baseline systolic blood pressure
No analyses of predictors for change in blood pressure or medication use were included
Exclusion of patients with MI <2 years before the second screening in Cohort II due to lack of validated MI endpoints after 2013
Only 44% and 55% of surviving MI patients in the original cohorts attended Tromsø 6 and Tromsø 7, respectively
Potential survival and selection bias towards more favourable blood pressure profiles, as non-attendees were older, had higher baseline systolic blood pressure, and were more likely to be smokers
Lack of validated MI endpoints after 2013 required excluding participants in MI-cohort II with an MI <2 years before their second screening

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Implication

Post-MI BP target achievement improved among women; leaves open whether sex-specific strategies enhance secondary prevention.

Abstract

Background: Recurrent cardiovascular events after myocardial infarction (MI) are frequent, and gender differences in blood pressure treatment have been reported. Despite increased focus on secondary prevention, recent reports indicate that treatment targets are not achieved. There is a need for gender-specific analyses of post-MI blood pressure treatment target achievement and antihypertensive medication adherence. Design: We investigated the change in systolic and diastolic blood pressure and antihypertensive drug use after first-ever MI over two time periods in a Norwegian population-based study. Methods: We followed 10 089 participants (55% women) attending the Tromsø Study in 1994-1995 (MI-cohort I) and 8412 participants (55% women) attending the Tromsø Study 2007-2008 (MI-cohort II) for first-ever MI up to their participation in 2007-2008 and 2015-2016, respectively. We used linear regression models to investigate sex and age differences in change in blood pressure. Results: A total of 396 participants in MI-cohort I and 131 participants in MI-cohort II had a first-ever MI in the observation periods. In MI-cohort I, 35% of the women and 52% of the men achieved the treatment targets of blood pressure <140/90 mm Hg (130/80 mm Hg if diabetic), while the proportions for MI-cohort II were 50% and 54% for women and men, respectively. Antihypertensive use was reported in 88% of women and 87% of men in MI-cohort I, and 76% of women and 81% of men in MI-cohort II. Conclusions: We found an overall low achievement of the treatment target. The findings call for better strategies for secondary prevention for both women and men.

Discussion

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Cite This Study

Hopstock et al. (2018) conducted a cohort in First-ever myocardial infarction (n=527). Female sex (post-MI secondary prevention) vs. Male sex (post-MI secondary prevention) was evaluated on Achievement of blood pressure treatment targets (<140/90 mm Hg, or <130/80 mm Hg if diabetic) after first-ever myocardial infarction in Cohort I (p=0.046). Women achieved post-MI blood pressure targets (<140/90 mm Hg) in 35% vs 52% of men in 1994-2008 (P=0.046) and 50% vs 54% in 2007-2016 (P=0.68).

synapsesocial.com/papers/6a81b28ca10297adb858be77 https://doi.org/10.1136/openhrt-2017-000746

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Blood pressure target achievement and antihypertensive medication use in women and men after first-ever myocardial infarction: the Tromsø Study 1994–2016

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Blood pressure target achievement and antihypertensive medication use in women and men after first-ever myocardial infarction: the Tromsø Study 1994–2016

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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