Eplerenone reduced all-cause mortality compared to placebo in post-MI heart failure patients with a history of hypertension (14% vs 18%; HR 0.71; 95% CI 0.59-0.85; P<0.0001).
Cohort (n=6,632)
Does eplerenone reduce mortality and cardiovascular events in post-acute myocardial infarction patients with heart failure, stratified by history of hypertension?
Eplerenone provides clinical benefits in post-myocardial infarction heart failure patients regardless of hypertension history, though the specific benefits (mortality reduction vs. heart failure hospitalization reduction) vary by hypertension status.
Effect estimate: HR 0.71 (95% CI 0.59 to 0.85)
Absolute Event Rate: 14% vs 18%
p-value: p=<0.0001
In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (n=6632), eplerenone-associated reduction in all-cause mortality was significantly greater in those with a history of hypertension (Hx-HTN). There were 4007 patients with Hx-HTN (eplerenone: n=1983) and 2625 patients without Hx-HTN (eplerenone: n=1336). Propensity scores for eplerenone use, separately calculated for patients with and without Hx-HTN, were used to assemble matched cohorts of 1838 and 1176 pairs of patients. In patients with Hx-HTN, all-cause mortality occurred in 18% of patients treated with placebo (rate, 1430/10 000 person-years) and 14% of patients treated with eplerenone (rate, 1058/10 000 person-years) during 2350 and 2457 years of follow-up, respectively (hazard ratio HR: 0.71; 95% CI: 0.59 to 0.85; P<0.0001). Composite end point of cardiovascular hospitalization or cardiovascular mortality occurred in 33% of placebo-treated patients (3029/10 000 person-years) and 28% of eplerenone-treated patients (2438/10 000 person-years) with Hx-HTN (HR: 0.82; 95% CI: 0.72 to 0.94; P=0.003). In patients without Hx-HTN, eplerenone reduced heart failure hospitalization (HR: 73; 95% CI: 0.55 to 0.97; P=0.028) but had no effect on mortality (HR: 0.91; 95% CI: 0.72 to 1.15; P=0.435) or on the composite end point (HR: 0.91; 95% CI: 0.76 to 1.10; P=0.331). Eplerenone should, therefore, be prescribed to all of the post-acute myocardial infarction patients with reduced left ventricular ejection fraction and heart failure regardless of Hx-HTN.
Pitt et al. (Tue,) conducted a cohort in Acute myocardial infarction complicated by heart failure (n=6,632). Eplerenone vs. Placebo was evaluated on All-cause mortality in patients with a history of hypertension (HR 0.71, 95% CI 0.59 to 0.85, p=<0.0001). Eplerenone reduced all-cause mortality compared to placebo in post-MI heart failure patients with a history of hypertension (14% vs 18%; HR 0.71; 95% CI 0.59-0.85; P<0.0001).
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