Control of blood pressure and risk of first acute myocardial infarction: Skaraborg hypertension project

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Abstract
Objective: To analyse the relation between treated blood pressure and concomitant risk factor and morbidity from acute myocardial infarction. Design: Prospective longitudinal study. Treated blood pressures and other variables were used to predict acute myocardial infarction. Setting: Primary health care in Skaraborg, Sweden. Subjects: 1121 men and 1453 women aged 40-69 years at registration at outpatient clinics, 1977-81, with no evidence of previous myocardial infarction were followed up for an average of 7.4 years. Subjects were undergoing treatment with drugs to lower blood pressure or had blood pressure that exceeded the systolic or diastolic limits, or both, for diagnosis (>170/>105 mm Hg (patients aged 40-60 years) and >180/>110 mm Hg (older than 60 years)) on three different occasions, or both. Main outcome measures: First validated event of fatal or non-fatal acute myocardial infarction. Results - In men but not in women there was a negative relation between treated diastolic blood pressure and risk of acute myocardial infarction. Left ventricular hypertrophy and smoking were contributory risk factors in both sexes, as was serum cholesterol concentration in men. In men with normal electrocardiograms (n=345) risk increased with increasing diastolic blood pressure (P=0.047), whereas the opposite was found in men with electrocardiograms suggesting ischaemia or hypertrophy, or both (n=499, P=0.009). In those with a reading of 95-99 mm Hg the relative risk was 0.30 (P=0.034); at >=100 mm Hg it was 0.37 (P=0.027). No similar relations were seen in women or for systolic blood pressure. Conclusion: It may be hazardous to lower diastolic20blood pressure below 95 mm Hg in hypertensive men with possible ischaemia or hypertrophy, or both. Electrocardiographic findings should be considered when treatment goals are decided for men with hypertension.