Prognostic value of a history of hypertension in 11483 patients with acute myocardial infarction treated with thrombolysis

Objective: To assess the prognostic value of a history of hypertension in patients with acute myocardial infarction (AMI) treated with thrombolysis. Design: Retrospective adjusted analysis of outcome data of patients with AMI randomly allocated to treatment in a controlled study of alteplase versus streptokinase and heparin versus no heparin. Setting: A highly representative sample (about 90%) of Italian Coronary Care Units. Patients: Patients with (n=3306) and without (n=7406) a history of treated hypertension. Main outcome measures: Morbidity and mortality during hospital stay and the next 6 months. Results: Patients with a history of hypertension had a significantly higher mortality, both in hospital and during the next 6 months. The difference persisted also after a multivariate analysis including all major prognostic factors for in-hospital and 6-month mortality, respectively. Left ventricular failure and recurrent ischaemic events (angina and re-infarction) were also significantly more frequent in hypertensives both during their hospital stay and during follow-up study. Conclusions: A history of hypertension is a negative independent prognostic factor after acute myocardial infarction treated with thrombolysis.