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July 7, 2010

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

JAMA. 2010;304(1):40-41. doi:10.1001/jama.2010.888

In Reply: In response to Drs Santana and Melo, this was an observational study focusing on data that can be used for prognostic purposes; this study design does not allow determination of mechanisms underlying the risks. The RIKS-HIA registry does not contain data on sleep apnea collected in any standardized way, so we agree with Santana and Melo that additional studies would be needed to assess an association between presence of sleep apnea and the poor prognosis associated with low systolic blood pressure. However, we do not believe that sleep apnea was a major determinant of the association we found between high blood pressure and good prognosis given that (1) our data were little affected when corrected for body mass index, (2) most patients with sleep apnea are obese, (3) others have shown that congestive heart failure is common in acute myocardial infarction,1 and (4) in patients with heart failure low blood pressure is associated with poor prognosis.2

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