Is elevated blood pressure associated with subacute myocardial infarcts (heart attacks)?

From the Guidelines

Elevated blood pressure is not necessary for subacute infarcts to occur, and in fact, blood pressure control is important for secondary prevention of cardiovascular events. Subacute infarcts represent a stage in the evolution of tissue damage following a myocardial infarction, and their presence is not directly related to current blood pressure readings. According to the 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation 1, the focus is on managing left ventricular dysfunction and acute heart failure, with recommendations for ACE inhibitor or ARB therapy, beta-blocker therapy, and mineralocorticoid receptor antagonist therapy to reduce the risk of hospitalization and death.

The development of an infarct depends primarily on interrupted blood flow to the heart tissue, which can result from various mechanisms including thrombosis, embolism, or hemorrhage. While hypertension is a significant risk factor for myocardial infarction, the presence of subacute infarcts on imaging studies reflects the timeline of tissue damage rather than current blood pressure readings.

During the management of patients with subacute infarcts, blood pressure control is important, with targets typically individualized based on the patient's specific situation, underlying conditions, and myocardial infarction etiology. Maintaining appropriate blood pressure (often below 140/90 mmHg) is generally recommended for secondary prevention of cardiovascular events, but this represents treatment rather than a prerequisite for the existence of subacute infarcts. The 2007 guidelines for the management of arterial hypertension also support the importance of blood pressure control in patients with coronary heart disease, with a target blood pressure of <130/80 mmHg 1.

Some key points to consider in the management of patients with subacute infarcts include:

• The use of ACE inhibitors or ARB therapy to reduce the risk of hospitalization and death 1
• The importance of beta-blocker therapy in patients with left ventricular dysfunction or heart failure 1
• The need for individualized blood pressure targets based on the patient's specific situation and underlying conditions 1
• The importance of monitoring serum potassium levels in patients receiving ACE inhibitors or ARB therapy 1

Overall, the management of patients with subacute infarcts requires a comprehensive approach that takes into account the patient's underlying conditions, myocardial infarction etiology, and individualized blood pressure targets.

From the Research

Elevated Blood Pressure with Subacute Infarcts

• The relationship between elevated blood pressure and subacute infarcts is complex, and management strategies may vary depending on the individual patient's condition 2, 3.
• In the subacute period after a stroke, permissive hypertension is initially warranted, but antihypertensive therapy should begin within 24 hours 3.
• The decision to lower blood pressure in patients with subacute infarcts should be based on individual patient factors, such as the presence of comorbid conditions like myocardial infarction, left ventricular failure, or aortic dissection 2.
• Current guidelines support the use of antiplatelet therapy, statin therapy, and control of diabetes mellitus to reduce the risk of future strokes 3, 4.
• The use of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors may be beneficial in reducing the risk of myocardial infarction and improving outcomes in patients with subacute infarcts 5, 6.
• However, the optimal blood pressure target for patients with subacute infarcts is not well established, and further research is needed to determine the best approach to managing blood pressure in these patients 2, 3.