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BIBTEX RIS

History of Hypertension and Eplerenone in Patients With Acute Myocardial Infarction Complicated by Heart Failure

2008; Lippincott Williams & Wilkins; Volume: 52; Issue: 2 Linguagem: Inglês

10.1161/hypertensionaha.107.109314

ISSN

1524-4563

Autores

Bertram Pitt, Ali Ahmed, Thomas E. Love, Henry Krum, José Carlos Nicolau, José Silva‐Cardoso, Alexander Parkhomenko, Michael Aschermann, Ramón Corbalán, Henry Solomon, Harry Shi, Faı̈ez Zannad,

Tópico(s)

Heart Failure Treatment and Management

Resumo

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.

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