Patterns and trajectories of long-term trajectory of blood pressure in patients with acute myocardial infarction and heart failure

Background In contemporary settings, the trajectory and patterns of blood pressure after discharge in patients with acute myocardial infarction (AMI) with heart failure (HF) remain unclear. Purpose We evaluated the serial changes and predictors of systolic blood pressure (SBP) after discharge in patients with AMI complicated by HF. Methods This prospective, multicenter registry included patients with AMI and HF who underwent primary percutaneous coronary intervention between November 2021 and March 2024. SBP was measured at discharge and at 1, 3, and 12 months in an outpatient setting. We illustrated the trajectory of SBP and the proportions of elevated blood pressure (SBP ≥140 mmHg) and hypotension (SBP <90 mmHg) during follow-up. In the multivariable analysis, predictors of elevated blood pressure at 1 or 3 months were also assessed. Results A total of 1050 patients were included in the present study, among whom 788 (75.0%) had hypertension at baseline. During the follow-up, the mean SBP increased from discharge to 1 month, with no significant differences thereafter (Figure). The proportions of patients with elevated SBP also increased from discharge to 1 month and then plateaued at 3 and 12 months, while those with hypotension remained low during the follow-up period (Figure). No prior history of myocardial infarction, a culprit vessel in the right or left circumflex coronary artery, and lower peak creatine kinase levels were independently associated with SBP ≥140 mmHg at 1 or 3 months. Conclusions In patients with AMI and HF, SBP increased from discharge to 1-month follow-up, with no significant changes thereafter, suggesting that elevated blood pressure may be masked during hospitalization. Patients with less severe manifestations of AMI were likely to have higher SBP in an outpatient setting. Our findings highlight the importance of recognizing blood pressure trajectories and patterns in the management of hypertension.