Long-term prognosis after acute myocardial infarction in patients with a history of arterial hypertension

Aims The objective of the study was to investigate the influence of a history of arterial hypertension on long-term prognosis after an acute myocardial infarction in a representative population, and secondly to assess the impact on prognosis of left ventricular systolic function in hypertensives after acute myocardial infarction. Methods A retrospective analysis of survival data on 6676 patients with acute myocardial infarction screened for entry into the TRAndolapril Cardiac Evaluation (TRACE) study. Follow-up time was 4–6 years. Results One thousand five hundred and seven (23%) of the patients had a history of arterial hypertension. During the time of observation 763 (50·6%) hypertensives and 2253 (43·7%) normotensives died, corresponding to a risk ratio for death in hypertensives of 1·23 (1·13–1·33, P<0·0001). In a multivariate analysis considering 12 other major risk factors after myocardial infarction, the risk ratio for death in hypertensives was 1·14 (1·04–1·24). There was a sig-nificant interaction between hypertension and age. Thus, hypertension only increased risk in patients aged 65 years or less (P<0·001). No interaction with left ventricular systolic function was found. Conclusion A history of arterial hypertension is a moderate risk factor for mortality after an acute myo-cardial infarction in patients aged 65 years or less. This excess risk is present at all levels of left ventricular systolic function.