Giuseppe Berton, Rocco Cordiano, Sebastian Mbaso, Renzo De Toni, Paolo Mormino and Paolo Palatini

Objective To assess the risk of mortality associated withhypertension and microalbuminuria in patients with acutemyocardial infarction.

Design  A prospective study.

Setting Intensive care units in three Italian generalhospitals.

Patients In total 309 consecutive patients (including 97women) aged 66.6 ± 12.5 years, admitted to hospital foracute myocardial infarction.

Main outcome measures Albumin excretion ratemeasured by radioimmunoassay of 24 h urine samples,on the first and third days after admission to hospital. In-hospital mortality rate among the patients stratifiedaccording to their history of hypertension and albuminexcretion rate.

Results Of the patients, 147 had histories ofhypertension. Forty-four per cent of the normotensive and43% of the hypertensive subjects had microalbuminuriaon the first day. On the third day the percentages were25 and 29%, respectively. Twenty-two patients diedbefore discharge from hospital. Patients were dividedinto four groups according to whether they hadmicroalbuminuria or not and likewise for hypertension.Mortality rate among the subjects with hypertension and microalbuminuria combined was greater than thoseamong the other three groups (P< 0.0001 on the firstand third days). The relative hazard ratio was 11.7 on thefirst day, and 15.6 on the third day. In a multivariate Cox’smodel hypertension and microalbuminuria combined hada greater predictive power for mortality than eithervariable alone. Killip class, age, and creatinine kinasesMB level were other significant predictors of death. ConclusionsThese results show that the combination of hypertension and microalbuminuria is associated witha greater risk of in-hospital mortality among subjectswith acute myocardial infarction, independently of degreeof heart failure and other possible confounders.

J Hypertension, 1998, 16;525-530.

Keywords myocardial infarction, hypertension, albumin excretion rate, in-hospital mortality