History of hypertension and eplerenone in patients with acute myocardial infarction complicated by heart failure

Pitt, B; Ahmed, A; Love, TE; Krum H.; Nicolau, J; Cardoso, JS; PARKHOMENKO A.; Aschermann, M; Corbalan, R; Solomon, H; Shi, H; Zannad, F

Abstract

In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (n=6632), eplerenone-associated reduction in all-cause mortality was significantly greater in those with a history of hypertension (Hx-HTN). There were 4007 patients with Hx-HTN (eplerenone: n=1983) and 2625 patients without Hx-HTN (eplerenone: n=1336). Propensity scores for eplerenone use, separately calculated for patients with and without Hx-HTN, were used to assemble matched cohorts of 1838 and 1176 pairs of patients. In patients with Hx-HTN, all-cause mortality occurred in 18% of patients treated with placebo (rate, 1430/10 000 person-years) and 14% of patients treated with eplerenone (rate, 1058/10 000 person-years) during 2350 and 2457 years of follow-up, respectively (hazard ratio [HR]: 0.71; 95% CI: 0.59 to 0.85; P<0.0001). Composite end point of cardiovascular hospitalization or cardiovascular mortality occurred in 33% of placebo-treated patients (3029/10 000 person-years) and 28% of eplerenone-treated patients (2438/10 000 person-years) with Hx-HTN (HR: 0.82; 95% CI: 0.72 to 0.94; P=0.003). In patients without Hx-HTN, eplerenone reduced heart failure hospitalization (HR: 73; 95% CI: 0.55 to 0.97; P=0.028) but had no effect on mortality (HR: 0.91; 95% CI: 0.72 to 1.15; P=0.435) or on the composite end point (HR: 0.91; 95% CI: 0.76 to 1.10; P=0.331). Eplerenone should, therefore, be prescribed to all of the post-acute myocardial infarction patients with reduced left ventricular ejection fraction and heart failure regardless of Hx-HTN. © 2008 American Heart Association, Inc.

Más información

Título según WOS: History of hypertension and eplerenone in patients with acute myocardial infarction complicated by heart failure
Título según SCOPUS: History of hypertension and eplerenone in patients with acute myocardial infarction complicated by heart failure
Título de la Revista: HYPERTENSION
Volumen: 52
Número: 2
Editorial: LIPPINCOTT WILLIAMS & WILKINS
Fecha de publicación: 2008
Página de inicio: 271
Página final: 278
Idioma: English
URL: http://hyper.ahajournals.org/cgi/doi/10.1161/HYPERTENSIONAHA.107.109314
DOI:

10.1161/HYPERTENSIONAHA.107.109314

Notas: ISI, SCOPUS