Blood pressure in survivors of myocardial infarction. The Coronary Drug Project Research Group.

The prognostic significance of blood pressure elevation and its associated characteristics in patients recovered from myocardial infarction was studied in the placebo group (n = 2,789) of the Coronary Drug Project. Age, relative body weight, heart rate and ST depression on the electrocardiogram were important positive correlates of hypertension measured at baseline. The relation of uric acid and elevated plasma glucose levels to increased blood pressure could be partially explained as side effects of thiazide diuretic therapy. A "high normal" baseline blood pressure best predicted the development of hypertension among survivors of myocardial infarction. Both combined systolic and diastolic hypertension and isolated systolic hypertension were adverse prognostic factors. Changes in blood pressure, including the prognostic implications of a decrease in pressure, were also analyzed in the subset of patients who sustained a recurrent nonfatal myocardial infarction. Decreases in systolic (mean 7.9 mm Hg) and diastolic (mean 3.6 mm Hg) blood pressure were sustained in this subset. Patients whose blood pressure decreased after recurrent myocardial infarction tended to have higher mortality rates than those of comparable patients whose blood pressure increased or remained unchanged.