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July 7, 2010

Supine Systolic Blood Pressure and 1-Year Mortality in Patients With Acute Chest Pain

JAMA. 2010;304(1):40-41. doi:10.1001/jama.2010.887

To the Editor: Dr Stenestrand and colleagues1 analyzed data from 119 151 participants in the Registry of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA) who were treated for chest pain in the intensive care unit from 1997 to 2007. The study reported that absolute 1-year mortality was 40.3% higher in quartile 1 (Q1, supine systolic blood pressure <128 mm Hg) compared with quartile 2 (Q2, supine systolic blood pressure 128-144 mm Hg), adjusted for age; sex; smoking status; diastolic blood pressure; use of antihypertensive medication and nitroglycerin at admission; and use at discharge of antihypertensive, statin, antiplatelet, and anticoagulant drugs and other lipid-lowering medication. As a study limitation, the authors said that “it is possible that factors not present in the RIKS-HIA database, such as malnutrition or anemia, might explain part of the relatively poor prognosis associated with low admission systolic BP.”1 However, another possible confounder is sleep apnea, an important pathophysiological and prognostic factor in cardiovascular disease.25

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