Clinical Significance of Initial Systolic Hypertension After Myocardial Infarction

To clarify the clinical significance of acutely raised systolic blood pressure (SBP) after myocardial infarction, 60 patients who were admitted within six hours after onset were studied. Initial systolic hypertension was shown in 26.6% of patients. Time-corresponding plasma epinephrine and norepinephrine levels were abnormally high in 61% and 86% of patients respectively. These high values of catecholamines were not, however, specific to systolic hypertension. On the contrary, an inverse correlation was observed between systolic blood pressure and plasma epinephrine value. It appeared that the anxiety and stress of chest pain do not contribute to raising blood pressure through catecholamine liberation. In the high pressure group (SBP ≥ 160 mmHg), only 3 of 16 patients were classified into severer grades (III or IV) of Killip's classification. This proved to be statistically significant. A similar result was obtained in Lown's grading. Only 1 of 16 patients showed severe ventricular tachyarrhythmia.

It appeared obvious from these data that patients who showed initial systolic hypertension are well protected from severe congestive heart failure and from life-threatening ventricular tachyarrhythmia in acute myocardial infarction.