Association Between Mean Systolic and Diastolic Blood Pressure Throughout the Follow-Up and Cardiovascular Events in Acute Myocardial Infarction Patients with Systolic Dysfunction and/Or Heart Failure: An Analysis from the High-Risk Myocardial Infarction Database Initiative
Key result
Mean systolic blood pressure ≤112 mmHg was associated with increased cardiovascular death compared to 121-128 mmHg (HR 2.49; 95% CI 2.26-2.74), likely representing reverse causality.
Why the study?
Is lower mean systolic blood pressure associated with increased cardiovascular death in acute MI patients with heart failure and/or systolic dysfunction?
Population
28,771 acute myocardial infarction patients with heart failure and/or systolic dysfunction pooled from 4…
Comparison
Lower mean systolic blood pressure quintiles… vs Reference mean systolic blood pressure quintile…
Design
Cohort
Follow-up
0.7 years for patients who died vs. 2.1 years for patients…
Authors
Discussion
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Member takes
Implication
Low SBP should not prompt higher targets in post-MI HF; leaves open reverse causality versus causal harm in observational data.
Study Design
Type
Observational (n=28,771)
Multicenter
Yes
Structured PICO
Is lower mean systolic blood pressure associated with increased cardiovascular death in acute MI patients with heart failure and/or systolic dysfunction?
P
Population
28,771 acute myocardial infarction patients with heart failure and/or systolic dysfunction (mean age 65 years, 30% female) analyzed for the association between mean blood pressure and cardiovascular events.
E
Exposure
Lower mean systolic blood pressure (SBP) quintiles throughout follow-up (≤112 mmHg and 113-120 mmHg)
C
Comparator
Reference mean systolic blood pressure (SBP) quintile of 121-128 mmHg
O
Outcome
Cardiovascular deathhard clinical
Main Result
Hazard Ratio: 2.49 (95% CI 2.26–2.74)
While systolic blood pressure <125 mmHg is associated with increased cardiovascular death in post-MI patients with heart failure or systolic dysfunction, this J-shaped curve likely represents reverse causality rather than a true harmful effect of lower blood pressure.
Limitations
- The association between low blood pressure and increased cardiovascular death likely represents a reverse causality phenomenon, as patients who died had shorter follow-up and fewer measurements.
- Likely reverse causality phenomenon (patients who died had shorter follow-up, fewer BP measurements, and lower mean BP prior to death)
Cite This Study
Ferreira et al. (2018) conducted an observational in Acute myocardial infarction with heart failure and/or systolic dysfunction (n=28,771). Mean systolic blood pressure ≤112 mmHg vs. Mean systolic blood pressure 121-128 mmHg was evaluated on Cardiovascular death (HR 2.49, 95% CI 2.26-2.74). Mean systolic blood pressure ≤112 mmHg was associated with increased cardiovascular death compared to 121-128 mmHg (HR 2.49; 95% CI 2.26-2.74), likely representing reverse causality.