| Hypertension (HT) and diabetes mellitus (DM) lead to structural and
functional cardiac impairment and worsen the prognosis after myocardial
infarction (MI). However, the prognosis of male or female patients
with the coexistence of HT and DM after MI has not been clearly demonstrated.
The study sample comprised 4317 consecutive patients with an acute
MI from a prospective nationwide survey conducted in 1992, 1994 and
1996 in all 25 coronary care units operating in Israel. The in-hospital,
30-day and 1-year outcome of diabetic hypertensive patients (n=546)
was compared with that of diabetic normotensive patients (n=547) and
with that of nondiabetic hypertensive patients (n=1192) and nondiabetic
normotensive subjects (n=2032). The crude in-hospital, 30-day and 1-year
mortality rates of diabetic hypertensive patients (11.7, 16.5 and 27.6%,
respectively) were significantly higher than those of the diabetic
normotensive patients (9.5, 15.4 and 22.9%, respectively) and nondiabetic
hypertensive patients (7.1, 11.6 and 17.6%, respectively). Kaplan-Meier
survival curves showed increased mortality rates during the 1-year
follow-up in diabetic hypertensive patients. Adjusted risk for 1-year
mortality was increased in diabetic patients. However, the risk was
similar in diabetic hypertensive and normotensive patients (hazard
ratio (HR) 1.55, 95% confidence interval (CI) 1.25-1.93, and 1.62,
95% CI 1.29-2.04, respectively). Adjusted Kaplan-Meier survival curves
of diabetic hypertensive patients converged with those of the diabetic
normotensives. The existence of DM increases the 1-year mortality after
MI by about 60%. However, controlled hypertension did not worsen the
outcome of diabetic male or female patients after MI |
