JAMA: High BP in ICU patients w/ chest pain have good one-year outcomes

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There is an inverse association between the level of supine systolic blood pressure (BP) measured on admission to an ICU for acute chest pain and risk of death at one year, with those patients having high systolic BP having a better prognosis after a year, according to a study published March 24/31 in the Journal of the American Medical Association.

High BP when measured after a resting period is among the best studied and established risk factors for cardiovascular disease, according to Fredrik H. Nystrom, MD, PhD, and colleagues from Linkoping University in Linkoping, Sweden. “However, little is known about the relationship between BP under acute stress, such as in acute chest pain, and subsequent mortality,” the authors wrote.

Nystrom and colleagues examined the death rate in relation to supine systolic BP measured at admission to an ICU for chest pain from 1997 through 2007. The study included analysis of data from 119,151 patients in a registry that includes all Swedish hospitals.

The researchers presented the results from this study according to systolic BP quartiles: Q1, less than 128 mm Hg; Q2, from 128 to 144 mm Hg; Q3, from 145 to 162 mm Hg; and Q4, at or above 163 mm Hg. Average follow-up time was 2.5 years. They found that the one-year mortality rate, after adjustment for various factors, showed that participants in Q1 of systolic BP had highest risk for death; conversely, patients in Q4 had the best prognosis.

“Corresponding adjusted absolute risks were a 21.7 percent lower absolute risk for death within one year for patients in Q4 compared with Q2,” the authors wrote. “The mortality risk was 15.2 percent lower for patients in Q3 compared with Q2 while the risk for patients in Q1 was 40.3 percent higher for mortality compared with that in Q2.”

“High supine systolic BP measured in patients with acute chest pain was associated with a favorable one-year prognosis,” Nystrom and colleagues concluded. “There is an inverse association between admission supine systolic BP and one-year mortality rate in patients admitted to the medical ICU for chest pain. This finding also applies to those patients who are diagnosed with ischemic heart disease and those who eventually develop [heart attack].”