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The relative risk of myocardial infarction in patients who have high blood pressure and non-cardiac pain

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Abstract

The authors conducted a population-based case-control study to determine the risk of myocardial infarction in patients who reported angina-like symptoms. The cases studied were those of patients who had high blood pressure and had sought treatment in 1984 with myocardial infarction as the first manifestation of coronary artery disease. Controls, a random sample of patients who had hypertension, were frequency-matched to cases by age and gender. Blind to case-control status, the authors reviewed the medical records of the 32 cases and 64 controls for reports of angina-like symptoms. While controls reported such symptoms at a constant rate, the events for the cases clustered near their infarctions. When a patient with hypertension sought medical advice for angina-like symptoms, the risk of infarction within 30 days was 14.2 (95% confidence interval, 2.8 to 71), and after 30 days it fell to 1.03. Among patients who have high blood pressure but no history of angina, presentations with prodromal symptoms in the primary care setting are so common that only about one in 100 such visits actually heralds myocardial infarction.

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Author notes

  1. Bruce M. Psaty MD, PhD

    Present address: the Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington

Authors and Affiliations

  1. the Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle, Washington

    Bruce M. Psaty MD, PhD

  2. Department of Medicine, University of Washington, Seattle, Washington

    James P. LoGerfo MD, MPH & Thomas S. Inui MD, ScM

  3. Department of Epidemiology, University of Washington, Seattle, Washington

    Thomas D. Koepsell MD, MPH

  4. Department of Health Services, University of Washington, Seattle, Washington

    Thomas D. Koepsell MD, MPH, James P. LoGerfo MD, MPH, Edward H. Wagner MD, MPH & Thomas S. Inui MD, ScM

  5. the Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington

    Edward H. Wagner MD, MPH

Authors
  1. Bruce M. Psaty MD, PhD
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  2. Thomas D. Koepsell MD, MPH
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  3. James P. LoGerfo MD, MPH
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  4. Edward H. Wagner MD, MPH
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  5. Thomas S. Inui MD, ScM
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Additional information

Supported in part by a grant from the Robert Wood Johnson Foundation, Princeton, NJ, and by the Health Services Research and Development Program, Veterans Administration Medical Center, Seattle, WA. The opinions, conclusions, and proposals in the text are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation or the VA Medical Center.

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Psaty, B.M., Koepsell, T.D., LoGerfo, J.P. et al. The relative risk of myocardial infarction in patients who have high blood pressure and non-cardiac pain. J Gen Intern Med 2, 381–387 (1987). https://doi.org/10.1007/BF02596362

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