Effect Of Blood Pressure On Admission And Hypertension History The Prognosis Of Patients Admitted With An Acute Coronary Syndrome In A Greek University Hospital

Objective: Hypertension is a major cardiovascular risk factor and closely relates to acute coronary syndromes (ACS). We sought to investigate the impact of initial blood pressure and history of hypertension in the extent of coronary artery disease, the in-hospital morbidity and the mortality of patients with the ACS. Design and method: Three hundred patients (mean age 63 ± 18 years, 228 males) admitted with ACS from 2016–2017 were included. Demographic characteristics and medical history were recorded. The extent of coronary artery disease was assessed in patients undergoing coronary angiography, as well as the number of patients that did not undergo coronary angiography. In-hospital complications that included reinfarction, arrhythmias, heart failure, stroke, mechanical complications, acute renal failure, urgent coronary artery bypass graft surgery, and death were estimated in all patients. Results: Prevalence of hypertension was high (n = 193, 64%). Prevalence of concomitant cardiovascular risk factors was also high in hypertensives (smoking 51.8%, hypercholesterolemia 54.4% and diabetes 36.3%). Hypertensives were older (70 vs. 59 years) compared to non-hypertensives (p < 0.001) and presented more often with non-ST ACS (67% vs 50%) compared to non-hypertensives (p < 0.01). Thirty-nine (39.4%) patients presented with one or more in-hospital complications (8 of them died). Blood pressure on admission was a predictor of both in-hospital mortality and morbidity and a decrease of systolic blood pressure per 1 mmHg increased by 4% the risk of in-hospital mortality and by 2% the risk of in-hospital complications (p < 0.01 and p < 0.05, respectively). Coronary angiography in hypertensives depicted lesions in two or more coronary vessels and hypertensives were more often managed conservatively compared to non-hypertensives (p < 0.05 for both). Nevertheless, neither left ventricular ejection fraction nor hospitalization days were different in hypertensives compared to non-hypertensives. In addition, both in-hospital morbidity and mortality had no significant difference between patients with or without hypertension Conclusions: Our study shows that hypertensive patients with ACS present more often with extensive coronary artery disease that, however, does not translate to short-term in-hospital morbidity or mortality. On the other hand, low blood pressure on admission predicts both in-hospital morbidity and mortality.