Predictors of acute myocardial infarction mortality in hypertensive patients treated in primary care

OBJECTIVE: To explore risk factors for acute myocardial infarction (AMI) mortality in hypertensive patients treated in primary care. DESIGN: Community-based cohort study. SETTING: Hypertension outpatient clinic in primary health care. SUBJECTS: Patients who consecutively underwent an annual follow-up during 1992-1993 (n =894; 377 men and 517 women). METHODS: All events of fatal AMI were ascertained by record linkage to the National Mortality Register to December 31, 2002. Gender-specific predictors for AMI mortality were analysed by Cox regression. MAIN OUTCOME MEASURE: AMI mortality. RESULTS: During a mean follow-up of 8.7 years 32 cases (8.5%) of fatal AMI were observed in men and 31 cases (6.0%) were observed in women. Most important predictors for AMI mortality in men were microalbuminuria (HR 3.8, CI 1.8-8.0) and left ventricular hypertrophy (HR 4.0, CI 1.7-9.4), whilst in women type 2 diabetes (HR 4.8, CI 2.4-9.8) was an important predictor. In hypertensive patients without diabetes male gender was associated with high AMI mortality (HR 2.7, CI 1.4-5.3), but in patients with both hypertension and type 2 diabetes the higher risk in men disappeared (HR 0.8, CI 0.4-1.7). CONCLUSION: Cardiovascular disease risk factors remain strong predictors of AMI mortality in hypertensive patients but with a different pattern in the two genders. Markers of organ damage are more important predictors in men, whereas markers of impaired glucose metabolism are more important predictors in women.