Hypertension and acute myocardial infarction: an overview

J Cardiovasc Med (Hagerstown). 2012 Mar;13(3):194-202. doi: 10.2459/JCM.0b013e3283511ee2.


History of hypertension is a frequent finding in patients with acute myocardial infarction (AMI) and its recurring association with female sex, diabetes, older age, less frequent smoking and more frequent vascular comorbidities composes a risk profile quite distinctive from the normotensive ischemic counterpart.Antecedent hypertension associates with higher rates of death and morbid events both during the early and long-term course of AMI, particularly if complicated by left ventricular dysfunction and/or congestive heart failure. Renin-angiotensin-aldosterone system blockade, through either angiotensin-converting enzyme inhibition, angiotensin II receptor blockade or aldosterone antagonism, exerts particular benefits in that high-risk hypertensive subgroup.In contrast to the negative implications carried by antecedent hypertension, higher systolic pressure at the onset of chest pain associates with lower mortality within 1 year from coronary occlusion, whereas increased blood pressure recorded after hemodynamic stabilization from the acute ischemic event bears inconsistent relationships with recurring coronary events in the long-term follow-up.Whether antihypertensive treatment in post-AMI hypertensive patients prevents ischemic relapses is uncertain. As a matter of fact, excessive diastolic pressure drops may jeopardize coronary perfusion and predispose to new acute coronary events, although the precise cause-effect mechanisms underlying this phenomenon need further evaluation.

Publication types

  • Review

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / drug effects
  • Female
  • Humans
  • Hypertension / drug therapy
  • Hypertension / epidemiology*
  • Hypertension / mortality
  • Hypertension / physiopathology
  • Hypertrophy, Left Ventricular / epidemiology
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / mortality
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / therapy
  • Prognosis
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Time Factors


  • Antihypertensive Agents