Blood pressure control in the year following coronary events

Background Blood pressure control is often insufficient in secondary prevention. The objective of the present study was to determine predictors for long-term elevated blood pressure (BP) in patients after coronary events. Methods Patients were included at admission to inpatient cardiac rehabilitation. A total of 18 cardiac rehabilitation centers in Germany participated. Indications for admission were myocardial infarction (MI), coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty (PTCA). The duration of follow-up was 12 months. Risk factors, medication, and clinical events were assessed from patients and their physicians. Results A consecutive sample of 1907 men (mean age 60 ± 10 years) and 534 women (mean age 65 ± 10 years) was admitted; the 12-month follow-up rate was 85%. Of all patients, 38% had a BP ≥ 140 and/or ≥ 90 mmHg at admission to the rehabilitation center compared to 48% at the 12-month follow-up. Patients with diabetes were less likely to achieve BP < 140/90 mmHg compared to patients without diabetes (43% vs. 56%; P < 0.001). In multivariable analyses, significant predictors for elevated BP after 12 months were baseline BP ≥ 140/90 mmHg (RR 2.5; 95% CI 1.7, 3.7), diabetes (RR 2.2; 95% CI 1.4, 3.5), and indication for admission (MI vs. CABG RR 0.6; 95% CI 0.4, 1.0, and PTCA vs. CABG RR 0.5; 95% CI 0.2, 1.0). Conclusions Long-term blood pressure control is not satisfactory in about half of the patients following coronary events. Particularly, patients with diabetes appear to be at risk for elevated blood pressure.