Cardiovascular and Cerebrovascular Diseases Induced by Air Pollution / 中国医学科学院学报

Air pollution has severe detrimental effects on public health.A substantial number of studies have demonstrated that air pollution exposure is a risk factor for the occurrence of cardiovascular and cerebrovascular diseases and a cause of non-communicable diseases.Both long-term and short-term exposure to air pollution are associated with respiratory diseases,stroke,coronary artery disease,and diabetes.Aiming to better understand the association,we reviewed the latest studies about the association of air pollution with cardiovascular and cerebrovascular diseases,especially stroke,coronary heart disease,arrhythmia,hypertension,and heart failure,and summarized the underlying mechanisms of the health damage caused by long-term and short-term exposure to air pollution.

Síndrome de uno y medio / One and a half syndrome

Se realizó una revisión bibliográfica con el objetivo de obtener información actualizada acerca de las características, diagnóstico y tratamiento del síndrome del uno y medio. Se emplearon principalmente las bases de datos disponibles en Infomed, Google Scholar y Pubmed. El síndrome del uno y medio es una entidad infrecuente, que se caracteriza por parálisis de la mirada conjugada horizontal y alteración del fascículo longitudinal medial ipsilateral secundario a diversas etiologías, entre las que se incluyen la enfermedad cerebrovascular y la esclerosis múltiple. Clínicamente se presenta con exotropía y nistagmo a la abducción. Su diagnóstico puede ser establecido en la exploración por las alteraciones típicas de los movimientos oculares, mientras que la imagen de resonancia magnética cerebral resulta indispensable para el diagnóstico diferencial y etiológico(AU)

One and a half syndrome is an infrequent condition characterized by conjugate horizontal gaze palsy and ipsilateral medial longitudinal fasciculus alteration secondary to various etiologies, including cerebrovascular disease and multiple sclerosis. Clinically, it presents with exotropia and abduction nystagmus. Its diagnosis may be established during exploration, due to the typical eye movement alterations, whereas brain magnetic resonance imaging is indispensable for differential and etiological diagnosis. A bibliographic review was conducted to obtain updated information about the characteristics, diagnosis and treatment of one and a half syndrome. Use was made of the databases available in Infomed, Google Scholar and Pubmed(AU)

Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history / 中华医学杂志(英文版)

BACKGROUND@#The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes.@*METHODS@#A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs).@*RESULTS@#The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88-40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001).@*CONCLUSIONS@#These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.

El glaucoma y las enfermedades sistémicas con compromiso vascular / Glaucoma and systemic diseases of vascular involvement

La presión intraocular es considerada el único factor causal potencialmente modificable con el propósito de prevenir la ceguera por glaucoma. Esta es una enfermedad multifactorial y, aunque es el factor de riesgo más importante en su desarrollo, la reducción de sus valores no garantiza el cese de la progresión del daño glaucomatoso. El glaucoma primario de ángulo abierto y el glaucoma de presión normal comparten factores de riesgo similares en la patogénesis y se pueden clasificar en categorías mecánicas y vasculares. La evidencia científica actual ha logrado demostrar que existe una importante asociación entre las enfermedades sistémicas con compromiso vascular, como la migraña, la apnea obstructiva del sueño, la hipotensión arterial de diferentes causas, la hipertensión arterial, la enfermedad cerebrovascular, la cardiopatía isquémica y la diabetes mellitus con los hallazgos a nivel ocular en pacientes con neuropatía óptica glaucomatosa. Esta correlación orienta a considerar estas enfermedades en conjunto para que cada profesional dedicado a la salud visual considere siempre imprescindible la evaluación de los aspectos que vinculan estas enfermedades para actuar en consecuencia. Se realiza una búsqueda sobre el glaucoma y las enfermedades sistémicas con compromiso vascular(AU)

Intraocular pressure is considered to be the only potentially modifiable causative factor to prevent glaucoma blindness. However, glaucoma is a multifactorial disease, and true as it is that its main risk factor is intraocular pressure, its reduction does not ensure cessation of the progress of glaucomatous damage. Primary open angle glaucoma and normal pressure glaucoma share similar pathogenetic risk factors, and may be classified as mechanical or vascular. According to current scientific evidence, an important association exists between systemic diseases with vascular involvement, such as migraine, obstructive sleep apnea, arterial hypotension of various causes, arterial hypertension, cerebrovascular disease, ischemic heart disease and diabetes mellitus, and ocular findings in patients with glaucomatous optic neuropathy. In view of this correlation, these diseases should be considered jointly, so that visual health professionals always bear in mind the evaluation of their common characteristics and act in consequence. A search was carried out on glaucoma and systemic diseases with vascular compromise(AU)

Comportamiento de factores de riesgo de las enfermedades cerebrovasculares en Pedras, Maranhão, Brasil / Behavior of risk factors of cerebrovascular diseases, Pedras, Maranhão Brazil

Se realizó un estudio descriptivo retrospectivo en el período comprendido noviembre de 2016 - agosto de 2017, con la finalidad de determinar los principales factores de riesgo que provocan la aparición de enfermedades cerebrovasculares (ECV) en la Unidad Básica de Salud de Pedras, municipio Matões do Norte, Maranhão, Brasil. El universo de estudio fue de 218 pacientes de 50 años y más. La fuente de obtención del dato fue una ficha diseñada a criterio del autor mediante la revisión de historias clínicas individuales y familiares. Entre las variables empleadas, se estudiaron: edad, sexo, raza, antecedentes familiares de ECV, factores de riesgos modificables y la asociación de factores de riesgos. Predominó el grupo etario de 70 a 79 años y el sexo masculino, así como los pacientes mestizos. Los principales factores de riesgos modificables fueron la hipertensión arterial y el tabaquismo, el 40.3 por ciento presentó 3 o más factores de riesgo, se emiten conclusiones y recomendaciones(AU)

A retrospective descriptive study was conducted in the from November 2016 to August 2017, in order to determine the main risk factors that cause the cerebrovascular diseases in the Basic Health Unit of Pedras municipality Matões do Norte Maranhão, Brazil. The studied universe was 218 patients aged 50 years and over. The source of data collection was a tab designed by the author through the review of individual and family medical records. The variables were studied: age, sex, race, family history of CVD, modifiable risk factors and the association of risk factors. The age group from 70 to 79 years and the male sex, as well as miscegenation in patients, the main modifiable risk factors were arterial hypertension and smoking, 40.3 percent presented 3 or more risk factors. Conclusions and recommendations are issued(AU)

First- Versus Second-Generation Drug-Eluting Stents in Acute Coronary Syndromes (Katowice-Zabrze Registry) / Stents Farmacológicos de Primeira Versus Segunda Geração na Síndrome Coronariana Aguda (Registro Katowice-Zabrze)

Abstract Background: There are sparse data on the performance of different types of drug-eluting stents (DES) in acute and real-life setting. Objective: The aim of the study was to compare the safety and efficacy of first- versus second-generation DES in patients with acute coronary syndromes (ACS). Methods: This all-comer registry enrolled consecutive patients diagnosed with ACS and treated with percutaneous coronary intervention with the implantation of first- or second-generation DES in one-year follow-up. The primary efficacy endpoint was defined as major adverse cardiac and cerebrovascular event (MACCE), a composite of all-cause death, nonfatal myocardial infarction, target-vessel revascularization and stroke. The primary safety outcome was definite stent thrombosis (ST) at one year. Results: From the total of 1916 patients enrolled into the registry, 1328 patients were diagnosed with ACS. Of them, 426 were treated with first- and 902 with second-generation DES. There was no significant difference in the incidence of MACCE between two types of DES at one year. The rate of acute and subacute ST was higher in first- vs. second-generation DES (1.6% vs. 0.1%, p < 0.001, and 1.2% vs. 0.2%, p = 0.025, respectively), but there was no difference regarding late ST (0.7% vs. 0.2%, respectively, p = 0.18) and gastrointestinal bleeding (2.1% vs. 1.1%, p = 0.21). In Cox regression, first-generation DES was an independent predictor for cumulative ST (HR 3.29 [1.30-8.31], p = 0.01). Conclusions: In an all-comer registry of ACS, the one-year rate of MACCE was comparable in groups treated with first- and second-generation DES. The use of first-generation DES was associated with higher rates of acute and subacute ST and was an independent predictor of cumulative ST.

Resumo Fundamento: Os dados sobre o desempenho dos diferentes tipos de stents farmacológicos (SF) no cenário agudo e da vida real são escassos. Objetivo: Comparar a segurança e a eficácia dos SF de primeira e de segunda geração em pacientes com síndrome coronariana aguda (SCA). Métodos: Este registro arrolou pacientes consecutivos com diagnóstico de SCA e tratados com intervenção coronariana percutânea e implantação de SF de primeira ou segunda geração em seguimento de 1 ano. O desfecho primário 'eficácia' foi definido como eventos cardíacos adversos maiores (ECAM), um composto de morte por todas as causas, infarto do miocárdio não fatal, revascularização de vaso-alvo e acidente vascular encefálico. O desfecho primário 'segurança' foi trombose de stent (TS) definitiva em 1 ano. Resultados: Do total de 1.916 pacientes arrolados, 1.328 foram diagnosticados com SCA. Desses, 426 foram tratados com SF de primeira geração e 902, com SF de segunda geração. Não houve diferença significativa na incidência de ECAM entre os dois tipos de SF em 1 ano. A taxa de TS aguda e subaguda foi maior com SF de primeira geração do que com os de segunda geração (1,6% vs. 0,1%, p < 0,001; e 1,2% vs. 0,2%, p = 0,025, respectivamente), mas não houve diferença para TS tardia (0,7% vs. 0,2%, respectivamente, p = 0,18) nem para sangramento gastrointestinal (2,1% vs.1,1%, p = 0,21). Na regressão de Cox, o SF de primeira geração foi preditor independente para TS cumulativa [HR 3,29 (1,30-8,31); p = 0,01]. Conclusões: No registro de SCA, a taxa de ECAM em 1 ano foi comparável nos grupos tratados com SF de primeira e de segunda geração. O uso de SF de primeira geração associou-se a maiores taxas de TS aguda e subaguda, sendo um preditor independente para TS cumulativa.

Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents

Following the implementation of a long-term care insurance system for the elderly in Korea, many nursing homes have been established and many more patients than ever before have been living at nursing homes. Despite the fact that this is a high-risk group vulnerable to hip fractures, no study has yet been conducted in Korea on hip fracture incidence rates and prognoses among patients residing at nursing homes. We recently studied 46 cases of hip fracture in nursing homes; more specifically, we investigated the most common conditions under which fractures occur, and examined the degree of recovery of ambulatory ability and the mortality within 1 yr. Among those who had survived after 1 yr, the number of non-functional ambulators increased from 8 hips before hip fracture to 19 hips at final post-fracture follow-up. These individuals showed poor recovery of ambulatory ability, and the number who died within one year was 11 (23.9%), a rate not significantly different from that among community-dwelling individuals. It was evident that hip-joint-fracture nursing home residents survived for similar periods of time as did those dwelling in the community, though under much more uncomfortable conditions. The main highlight of this report is that it is the first from Korea on nursing home residents' ambulatory recovery and one-year mortality after hip fracture. The authors believe that, beginning with the present study, the government should collect and evaluate the number of hips fractured at nursing facilities in order to formulate criteria that will help to enable all patients to select safer and better-quality nursing facilities for themselves or their family members.

A Study of Cerebro Vascular Accident Patients.

To find out the proportion of different types of strokes among the CVA patients and to examine the correlation between stroke and various risk factors. Patients and Methods: Sixty CVA patients who attended the department of Medicine of TMC & Dr.BRAM Teaching hospital comprised the material for this study. Detailed history, clinical examination especially CNS examination, different biochemical and radiological investigations including CT Scan were performed to establish the diagnosis of CVA and to confirm the type of CVA. Various risk factors then correlated in causation of CVA. Result: Out of 60 CVA patients 42(70%) had ishaemic and 18(30%) had haemorrhagic stroke. Among the 42 ischaemic stroke patients 12 (20%) had lacunar stroke. 38 patients (63.3%) had hypertension, out of which only 4 (15%) had regular follow up showing that hypertension is a definite risk factor. Serum Cholesterol (213.52 ± 32.97) and Serum Triglyceride (176.25 ± 41.97 ) were statistically significant (p<0.01) along with Serum LDL (117.88 ± 27.18) and VLDL (49.11 ± 13.76),t value 5.096 and 5.128 respectively. In this study 14 (23.3%) patients had diabetes mellitus, 31 (51.6%) smokers, 14 (23.3%) alcoholics and 15 (25%) overweight, but none of them could be established as a statistically significant risk factor.

Cerebrovascular Diseases and Associated Risk Factors in WHO Eastern Mediterranean Countries.

Background: In the WHO Eastern Mediterranean region, nearly one million deaths are caused by cardio-vascular diseases every year. During the last decade, the number of deaths caused by stroke increased by 23%. Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, alcohol, unhealthy diet, physical inactivity, and metabolic risk factors like obesity, high blood pressure, diabetes and raised lipids. Methods: This is a systematic review on cerebrovascular diseases and associated risk factors in WHO Eastern Mediterranean countries. Medline, Science Direct, and other sources were used to get peer reviewed papers dealing with the review theme. The search was limited to publications between 1990 and 2013 (30th June). Results and Discussion: According to the inclusion criteria, 45 papers were included in the present review. The prevalence was found greater than 50% in 38 studies for hypertension, greater than 25% in 36 studies for diabetes, greater than 15% in 26 studies for smoking and greater than 25% in 19 studies for dyslipidemia. It was also indicated that incidence of stroke increases with ageing. The majority of studies found a prevalence of stroke higher in men than in women with a ratio male: female reaching 3.55:1 in one study. Conclusion: Although at different levels of importance, all the studies reveal that hypertension, diabetes, dyslipidemia and smoking are crucial risk factors for stroke. This review also indicates a lack or scarcity of studies in many countries with an uneven contribution by country since 33% of studies are from Pakistan whereas North Africa (Egypt, Morocco, Libya, Tunisia) contributed with only 2 papers.

Infective causes of stroke in tropical regions

Vascular diseases of the brain are the second reason of the death and the first cause of morbidity and disability worldwide. In tropical areas stroke has some particular features related to the nature of torrid zones. There are some special causes of the stroke, mainly infectious, although some of them are non-infectious. The most important etiologies are malaria, tuberculosis, cysticercosis, syphilis, and Chagas' disease. The mean age of the patients with stroke in tropical areas seems to be less than that in developed countries, and the disease is more prevalent in younger adults. Prevention and/or treatment of the classic risk factors as well as factors related to tropical zones are the mainstays of controlling the disease. It has to be mentioned that lack of human as well as financial resources makes it difficult to control and treat the disease properly. Herein, the etiologies and risk factors of the cerebrovascular diseases in tropical regions will be reviewed

Factores de riesgo de la enfermedad cerebrovascular en ancianos pertenecientes al Policlínico Universitario Milanés, Matanzas, 2007-2008 / Risk factors of cerebrovascular disease in elder people belonging to University Policlinic Milanés, Matanzas, 2007-2008

Se realizó un estudio observacional, prospectivo y descriptivo, con el objetivo de caracterizar el comportamiento de la enfermedad cerebrovascular de la población anciana, perteneciente a tres consultorios del Equipo Básico No. 3, del Policlínico Universitario Milanés. Se aplicó la encuesta del grupo de investigación 10/66 —avalada internacionalmente— a 183 ancianos con enfermedad cerebrovascular, pertenecientes a los tres consultorios. Los datos fueron procesados y se expresaron los resultados en tablas y gráficos. Resultó significativo que la enfermedad afectó predominantemente al sexo masculino, en las edades entre 75 y 79 años, y entre los factores de riesgos se destacaron: el consumo de dieta no saludable, la hipertensión arterial y las enfermedades cardiovasculares, entre otras. Las complicaciones post enfermedad cerebrovascular se presentaron en la mayoría de los ancianos estudiados, y entre las más frecuentes se señalaron las infecciones intercurrentes. Se arribó a la conclusión de que la enfermedad cerebrovascular es una de las causas más importantes de morbilidad en la población anciana, con grandes implicaciones económicas y familiares

We carried out an observational, prospective and descriptive study with the objective of characterizing cerebrovascular disease's behaviour in elder population belonging to three family physician's office of the Basic Team No. 3, University Policlinic Milanés. We applied the survey of the investigation group 10/66 —internationally endorsed— to 183 elder people with cerebrovascular disease, belonging to three family physician's office. Data were processed and the results showed in tables and charts. It was significant that the disease affected mainly the male genre, at the ages between 75 and 79 years, and among the risk factors there stood out: non healthy diet consumption, arterial hypertension and cerebrovascular diseases, among others. There were complications after the cerebrovascular disease in most of the studied elder people, and among the most frequent were the intercurrent infections. We arrived to the conclusion that the cerebrovascular disease is one of the most important causes of morbidity in the elder population, with great familiar and economic implications

Reversible cerebral vasoconstriction syndrome / Síndrome de vasoconstricción cerebral reversible

Background: Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache associated with multifocal vasoconstriction of cerebral arteries in patients without aneurysmal subarachnoid hemorrhage (SAH). The vasoconstriction reverts within three months. We report a 44-year-old man who had a thunderclap headache during sexual intercourse. A similar episode occurred at rest 36 hours later. The patient had already experienced a thunderclap headache 10 years earlier, during coitus. There were no abnormalities on examination. His brain computed tomography scan was normal and cerebrospinal fluid analysis showed no xanthochromia, 15 WBC/mm³ and 10 RBC/mm³. Lumbar puncture was repeated two days later (WBC = 3/mm³ and RBC = 43/mm³). An initial digital cerebral angiography showed a diffuse segmental intracerebral vasospasm. A new angiography after 15 days was normal. He remains headache-free after twenty six months. In conclusion, patients who have thunderclap headache with normal brain CT and cerebrospinal fluid without xantochromia should be investigated for this syndrome.

El síndrome de vasoconstricción cerebral reversible se caracteriza por una cefalea lancinante asociada a una vasoconstricción multifocal de las arterias cerebrales, en pacientes sin hemorragia subaracnoidea causada por aneurismas. La vasoconstricción se revierte en un plazo de tres meses. Presentamos un paciente varón de 44 años que experimentó una cefalea lancinante durante el acto sexual. Un episodio similar repitió 36 horas después, pero mientras estaba en reposo. El paciente había sufrido una cefalea lancinante durante el coito, 10 años antes. El examen físico fue normal. La tomografía cerebral estaba normal y el líquido cefalorraquídeo era claro, con 15 leucocitos y 10 eritrocitos por mm³. Una angiografía cerebral digital mostró un vasoespasmo intracerebral difuso segmentario. Una nueva angiografía, efectuada 15 días después, fue normal. El paciente está libre de cefaleas después de 26 meses de seguimiento.

Consequências do ronco não-tratado / Consequences of untreated snoring

Em alguns estudos, o ronco tem sido associado com um risco aumentado de hipertensão, doença cardíaca isquêmica e acidente vascular encefálico. Os mecanismos são desconhecidos, mas provavelmente mediados pela apneia obstrutiva do sono. Contudo, a maioria dos roncadores não tem apneia do sono. Se o ronco, por si só, aumenta o risco de doença cardiovascular, isso ainda permanece controverso.

In some studies, snoring has been associated with an increased risk of hypertension, ischemic heart disease and stroke. Although the mechanisms involved in these associations are unknown, they are probably mediated by obstructive sleep apnea. Nevertheless, most snorers do not have sleep apnea. Whether snoring itself increases the risk of cardiovascular disease remains controversial.

Factores de riesgo cardiovascular en el paciente con infección por VIH / Cardiovascular risk factors in patients with HIV infection

Tras la implantación del tratamiento antirretroviral, el SIDA se ha convertido en una enfermedad crónica en los países desarrollados. El riesgo cardiovascular parece ser algo mayor en los pacientes VIH que en los no infectados. Tras la introducción de la terapia antirretroviral, diversas alteraciones metabólicas se observaron, principalmente relacionadas al perfil lipídico y resistencia a la insulina. Esto se debió al propio VIH, a la terapia antirretroviral y a la elevada prevalencia de factores clásicos de riesgo. Varias líneas de evidencias sugirieron que la aterosclerosis puede ser más frecuente o desarrollarse más rápido en individuos HIV+, especialmente los tratados con las potentes combinaciones de antirretrovirales. Esta novedosa necesidad de abordar el riesgo cardiovascular como parte del cuidado del paciente VIH resalta la importancia de tratar al paciente de forma global.

After the introduction of the antiretroviral treatment, AIDS has become a chronic disease in developed countries. Cardiovascular risk seems to be a little bigger in HIV patients than in non-infected ones. After introducing antiretroviral therapy, several metabolic disturbances have been observed, related mainly with the lipid profile and insulin resistance. It is due to the same HIV, the antiretroviral therapy and a high prevalence of classical risk facts. Several evidence traces suggest that atherosclerosis may be more frequent or may develop faster in HIV+ individuals, especially in those treated with potent antiretroviral combinations. This new necessity of affronting cardiovascular risk as part of HIV patients care highlights the importance of treating the patient in a global form.

A propósito de un caso de apnea del sueño (SAOS): una entidad omitida en los baremos / Case report sleep apnea: a clinical situation omitted in our legislation

La patología en el acto de respirar durante el sueño es rica y variada, centrándose en los síndromes de apnea del sueño. El síndrome de apnea obstructiva del sueño incluye nombres alternativos como son: apnea del sueño, apnea obstructiva del sueño, síndrome de apnea del sueño, apnea mixta, síndrome de hipopnea obstructiva y síndrome de resistencia de la vía respiratoria alta. Es una patología causal de un gran número de accidentes y ausentismo laboral. Llamativamente, ningún baremo de uso oficial o no al momento presta consideración a esta patología clínicamente relevante, por lo cual corresponde su atención medicolegal para la determinación de incapacidad resultante ante su presencia. Ante su ausencia, se hace necesario recurrir a lo mecanismos fisiopatológicos intervinientes a fin de lograr un adecuado encuadramiento en los baremos de uso, en base al principio de un punto de vista de la analogía jurídica.

The pathology of the act to breathe during the dream rich and is varied, concentrating in the syndromes of apnea of the dream. The syndrome of obstructive apnea of the dream includes alternative names e.g.: apnea of the dream, obstructive apnea of the dream, syndrome of apnea of the dream, mixed apnea, syndrome of obstructive hypopnea and syndrome of resistance of high the respiratory tract. It is a causal pathology of a great number of accidents and labor absenteeism. Showy, no scale of official use or no, at the quick moment consideration to this clinically relevant pathology, thus deserve its legal medical attention, for the determination of resulting incapacity before its presence. Before his absence, one becomes necessary to resort to the intervening physiopathological mechanisms, in order to obtain a suitable frame in the used scales, on the basis of the principle of a point of view of the legal analogy.

Clinical Effects of Hypertension on the Mortality of Patients with Acute Myocardial Infarction

The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class > or =III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade < or =2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.