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Hypertension and Myocardial Infarction: a Study and Review Central Journal of Cardiology & Clinical Research Bringing Excellence in Open Access Research Article *Corresponding author Abha Pandit, Department of Medicine, Index Medical Hypertension and Myocardial College, Indore, Madhya Pradesh, India, Email: Submitted: 18 July 2017 Accepted: 09 September 2017 Infarction: A Study and Review Published: 11 September 2017 Abha Pandit* Copyright © 2017 Pandit Department of Medicine, Index Medical College, Hospital and Research Centre, India OPEN ACCESS Abstract Keywords Aim: Regional pattern and significance of risk determinants paving the way to • Hypertension incidence and fate of myocardial infarction (MI) in hypertensive subjects is attempted • Myocardial infarction elaboration through comparison with contemporary cases of MI in normotensive • Ischaemic heart disease patients in an 18 month long study at medical college hospital setting in central • HbA1c (Glycosylated hemoglobin India. Method: MI cases in 35 to 75 year age range without major unrelated systemic diseases were studied in hypertensive and normotensive categories. Demographic, clinical and laboratory information, as well as complications and outcome, were examined. Results: MI in hypertension associated earlier age, more with positive family history of ischaemic heart disease, overweight, poor physical activity, deficient fresh fruit intake and the smoking habit. Uncontrolled diabetes significantly associated MI in hypertension as also deficient plasma antioxidant capacity. Hypertensive MI also had marginally increased rates of dyslipidaemia, and renal function declines. Incidence of various cardiac complications were insignificantly higher hospital stay was prolonged in hypertensive MI. Conclusion: Pattern of risk factors and clinical course of MI in studied categories emphasized preventive dietary and physical activity measures for weight reduction, deterrence of smoking and good control of co-existing diabetes as most pertinent to bring down incidence and possibly severity of MI in hypertension, in central Indian context. Particular reference to antihypertensive cum cardioprotective drug classes angiotensin converting enzyme (ACE) inhibitors and angiotensin (AT)-II receptor blockers, beta blockers and calcium channel blockers is made in the context. INTRODUCTION ischaemic heart disease. HTN induces ventricular hypertrophy and together with that further compromises myocardial Hypertension (HTN) is a major cause of mortality and perfusion. The mechanisms include decrease in capillary density morbidity and is expected to affect 1.56 billion people by 2025 [11], failure of capacity to vasodilatation with increased muscle [1].Currently 31.4% of Indian population is estimated to suffer mass [12], an increased resistance for coronary collaterals HTN [2]. Elevated blood pressure is the key risk factor for [13] and more severe sub-endocardial involvement and larger cardiovascular disease [3,4]. Myocardial infarction (MI) is major ischaemic zones [13]. There is linear increase in risk of MI with cause of mortality and morbidity, often resulting as complication increase of blood pressure status. HTN particularly raises the risk of HTN. Almost 40% of patients with ischaemic heart disease of MI in people under 65 years [14]. (IHD) who die suddenly have history of HTN [5]. Over 90% of MI victims bear many risk factors for coronary atherosclerosis Commonest basis for MI is atherosclerotic disease of besides HTN, viz. smoking habit, obesity, dyslipidaemia etc coronaries with thrombosis, spasm or plaque rupture, the [6]. HTN is independent risk factor over other risk factors precipitating entity being atheroma. HTN increases the that may coexist [7]. Heart failure, stroke and other modes of prevalence of occlusive disease of coronaries [15]. Several cardiovascular mortality are higher among hypertensive patients studies have reported that hypertensive patients had higher [8,9]. Immediate and long term mortality after infarction is instances of heart failure, stroke and cardiovascular death [9,16]. increased in hypertensives partly due to increased instances of Hypertensive patients suffer multivessel coronary disease and myocardial and septal rupture [10]. complex coronary lesions contributing to worse outcome of MI. Hypertension and IHD Aggravated atherosclerosis, left ventricular hypertrophy, insulin resistance, endothelial damage and ventricular arrhythmias HTN causes myocardial perfusion and ventricular function all worsen prognosis [17]. Hypertensive MI patients suffer abnormalities, independent of the consequences associating higher instances of postinfarct angina pectoris, recurrent silent Cite this article: Pandit A (2017) Hypertension and Myocardial Infarction: A Study and Review. J Cardiol Clin Res 5(6): 1118. Pandit (2017) Email: Central Bringing Excellence in Open Access myocardial ischaemia and infarction, atrial and ventricular on history of MI in parent or sibling male fewer than 55 and female less than 65 year age [29]. History of HTN, diabetes normotensive MI cases [9,18,19]. or cerebrovascular disorder constituted positive history fibrillation, cardiogenic shock and pulmonary oedema than irrespective of age. Body mass index (BMI) was calculated as IHD risk due to HTN however is seen to vary among ratio of body weight to height squared and >25kg/m2 was taken populations and is low in black Africans who generally display rate was estimated from serum creatinine levels [31]. Physical world HTN in Asians has unique traits in terms of response to activityas indicative status of obesitywas assessed in our patientsby enquiring [30]. Glomerular usual activity filtration and antihypertensivelower serum cholesterol medication, profiles complications [20]. In contrast and outcome to western [21]. minimum 30 minute daily brisk exercise for at least 5 days in a Due to high prevalence of HTN and diabetes, risk of stroke week was deemed as active while less than that as inactive status. Fresh fruit intake was enquired as kind and quantity of fresh fruits variation in prevalence of coronary heart disease is documented consumed over the week and the month. An average minimum inand Asia coronary [23,24]. disease Need foris highstudies in Asiato asses [22]. nuances Significant and regionalfeatures alternate day consumption of apple size fruit irrespective of of hypertensive patients in Asia are emphasized [25], in order economic status was taken as positive consumption and less to optimally translate western recommendations of prevention as negative. Standard procedures were used for estimation of and management. HTN related risk factors (including obesity and diabetes) and unhealthy lifestyle particularly, deserve keen Oxidative stress markers and antioxidant capacity may vary as evaluation [26]. The present observational study attempted perHbA1c, time creatinine, since occurance lipid profileof event. as These previously parameters described were [28].also level was determined as thiobarbituric acid reactive substances evidenceappraisal baseof clinical for suitable profile and clinical course practices of MI among for prevention normotensive and [32],estimated as indicator on the firstof oxidative day of admission. stress. Total Plasma plasma malonaldehyde antioxidant management.and hypertensive cases in our specific region to generate capacity was determined by FRAP (ferric oxide reducing ability PATIENTS AND METHODS of plasma) method [33].Infarct localization and hospital outcome in respect to complications, length of hospital stay and mortality The study is based on consecutively admitted MI patients in were also studied. medical wards of Index Medical College, Indore (Central India), between January 2015 to June 2016 period. Patients above 35 Relative frequency distributions of subjects in two compared years to 75 years age of either sex were included. Patients that groups in respect to every parameter were analyzed. Parameters had antecedent or subsequently diagnosed systemic diseases employed cut off as yes/no, general median value or given unrelated to occurrence of MI were excluded. Although records normal value. Chi square test and when necessary (for small cell were not kept the excluded sample constituted around 10% numbers), Fishers exact test statistic were used. of all screened. The exclusion was a preliminary measure to minimize complicated inferences on group differences. Of the OBSERVATION AND RESULTS Table 1, presents the comparison of presenting clinical and 95 were hypertensive, revealed either through history and/or detected132 cases upon finally examination included, 37(Blood were pressure normotensive >140/90 and mm the Hg),rest Higher proportion of hypertensive MI patients was younger at admission. MI diagnosis was based on patient meeting at laboratory profile in two groups. under the median 62 years compared to the normotensive group least two of the following three criteria viz. typical chest pain/ discomfort lasting 30 minutes at least; an electrocardiographic by BMI above 25 was more prevalent among hypertensive prominent Q wave and/or ST segment elevation of >2mm in two but the gender composition was not different. Obesity defined contiguous precordial leads and abnormal rise of creatine kinase coronary disease was present in hypertension group. History of MB, indicative of myocardial necrosis. MI group. Significantly higher prevalence of family history of The study protocol was approved by the college research ethical committee. For use of all information relating patient’s thepast hypertensive
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