Prognosis of men with coronary heart disease as related to blood pressure

A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy

BACKGROUND

Posterior circulation stroke is characterized by poor prognosis because its optimal thrombolysis "time window" is always missed. After mechanical thrombectomy (MT), the recanalization rate of posterior circulation obstruction is significantly increased, but prognosis remains poor. To best manage patients, prognostic factors are needed to inform MT triaging after posterior circulation stroke.

METHODS

A systematic literature search was done for the period through April 2020. Studies included those with posterior circulation stroke cases that underwent MT. The primary outcome measure in this study was the modified Rankin Scale on day 90.

RESULTS

No outcome differences were found in gender, atrial fibrillation, smoking, and coronary artery disease (OR = 1.07, 95% CI: 0.90-1.28; OR = 1.02, 95% CI: 0.82-1.26; OR = 1.26, 95% CI: 0.94-1.68; and OR = 0.84, 95% CI: 0.58-1.22, respectively). Hypertension, diabetes mellitus, and previous stroke correlated with poorer prognosis (OR = 0.61, 95% CI: 0.48-0.77; OR = 0.60, 95% CI: 0.50-0.73; and OR = 0.74, 95% CI: 0.55-0.99, respectively). However, hyperlipidemia correlated with better prognosis (OR = 1.28, 95% CI: 1.04-1.58).

CONCLUSION

Our analysis indicates that hypertension, diabetes mellitus, or previous stroke correlate with poorer outcomes. Intriguingly, hyperlipidemia correlates with better prognosis. These factors may help inform triage decisions when considering MT for posterior circulation stroke patients. However, large, multicenter, randomized controlled trials are needed to validate these observations.

Mortality and morbidity during 13.5 years' follow-up in relation to blood pressure. The study of men born in 1913

A total of 973 50-year-old men, randomly selected from the general population in Göteborg, Sweden, were invited to a survey in 1963. Altogether 855 men (88%) participated. They have been followed up for 13.5 years, and this report presents mortality and morbidity during this time in relation to BP at the time of the initial examination. BP was strongly associated with mortality regardless of its cause. This was due to a close relation of BP to mortality from ischaemic heart disease and a weak but significant relation to mortality from cancer. BP was also strongly related to morbidity from myocardial infarction, stroke and angina pectoris, showed a tendency towards relation to morbidity from intermittent claudication and kidney stone, and was negatively related to morbidity from neoplasm for survivors. BP was also related to pension but not to sick leave. There is no indication of a decreasing importance of BP as a risk factor in this age period.

Tolerability of combined treatment with verapamil and beta-blockers in angina resistant to monotherapy

We have used a combination of a beta-blocker and verapamil to treat 42 consecutive patients with angina resistant to either agent alone. Patients with heart failure, heart block or uncontrolled hypertension were excluded. The mean duration of follow-up was 6.5 months. Thirty-six patients (81%) reported an improvement and the number of angina attacks was reduced from 17/week to 5/week. Side effects necessitated withdrawal of one or both drugs in 6 patients, 2 of whom developed bradyarrhythmias not solely related to drug treatment. The most common complication was mild left ventricular failure (6) treated by reducing or stopping the beta-blocker. The data suggest that the combination of verapamil and a beta-blocker may be used in a relatively unselected group of patients with difficult angina. However, as dosage adjustment and close observation may be necessary to minimise side effects, the use of this combination should be limited to hospital practice.

Acute cerebrovascular and myocardial ischemia superimposed upon chronically hypertensive and arteriosclerotic male Sprague-Dawley rats

Repeatedly bred male rats which develop arteriosclerosis spontaneously were subjected to unilateral nephrectomy, 1% saline drinking water, and 2 mg subcutaneous injections of deoxycorticosterone acetate per animal weekly for 7 weeks to induce severe hypertension (+/- 175 mmHg systolic). Acute cerebral ischemia was induced by ligating one carotid artery. Two days later, experimental animals were subjected to acute myocardial ischemia by injecting them subcutaneously with a single dose of isoproterenol (25 mg/100 g body weight). All of the experimental animals died within 4 hours of the injection of isoproterenol. During this same period, blood pressure, body weight, thymus, kidney, and testicular weights were reduced, whereas heart and adrenal gland weights increased markedly. Serum enzymes (CPK, SGOT, and LDH), lipids (triglycerides and free fatty acids), glucose, BUN, and corticosterone rose progressively. Fatty infiltration of the liver, adrenal hyperplasia, myocardial thrombi, renal degenerative changes, and cerebral edema became progressively more severe. A hypothalamic-pituitary-adrenal axis component may be involved in the reaction to the stress of acute cerebral or myocardial ischemia, which is intensified when the two ischemias are combined, and chronic hypertension may exacerbate both.

Factors affecting the 5 year survival rate of men following acute coronary heart disease

A total of 213 male patients who survived an initial episode of acute coronary inusfficiency or myocardial infarction for 28 days have been followed for 5 years. The effect of age, weight, severity of infarction diastolic blood pressure, serum cholesterol, and cigarette smoking at the time of the initial attack on postinfarction morbidity and death was examined. Only severity of infarction adversely influenced the long-term mortality rate; none of the factors studied was related to subsequent morbidity. The effect of subsequent cigarette smoking on morbidity and death was noted over the 5 year period. Smoking did not affect subsequent morbidity but there was an increased death rate among those who continued to smoke. This effect of smoking was independent of the severity of infarction. Improved long-term survival may be predicted for patients who stop or markedly reduce cigarette smoking.

Factors influenceing long-term prognosis in male patients surviving a first coronary attack

Three hundred and sixty-four men who survived a first episode of acute coronary insufficiency or myocardial infarction for 28 days were admitted to a coronary heart disease secondary programme between 1 January 1961 and 31 December 1971. Of these, 252 have been followed for at least 4 years. The 4-year mortality was 13.5 per cent (34 patients). The average mortality was 3.4 per cent but an excess of deaths occurred during the first year of follow-up. Of 11 characteristics measured during the acute attack, only severity of the attack was significantly associated with poor 4-year survival. Cigarette consumption after infarction was significantly less among those surviving the 4-year period when compared with decedents. Follow-up systolic and diastolic blood pressure levels were significantly lower among decedents. No significant differences were noted in serum cholesterol levels and in mean weight, The presence of post-infarction angina did not affect the prognosis.