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August 17, 2011

Erythropoietin in Patients With ST-Segment Elevation Myocardial Infarction—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: MedStar Health Research Institute, Washington, DC (Dr Najjar) (samer.s.najjar@medstar.net); and Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina (Drs Rao and Harrington).

JAMA. 2011;306(7):705-706. doi:10.1001/jama.2011.1145

In Reply: Drs Krapf and Hulter inquire whether the increased risk of death, recurrent MI, stroke, or stent thrombosis in the active treatment group of the REVEAL trial may have been related to erythropoietin's hypertensive effect. This effect is thought to be related to arterial vasoconstriction and independent of erythropoietin's effect on hematocrit and blood viscosity.1 The REVEAL trial excluded patients with uncontrolled hypertension, defined as a systolic BP greater than 180 mm Hg or a diastolic BP greater than 110 mm Hg. Blood pressure did not differ between the 2 treatment groups at baseline, nor at the first time point that was assessed, a mean (SD) 24 (12) hours after study drug administration. In both the active and placebo treatment groups, systolic BP decreased on average from baseline to the first time point (by 11 [21] and 13 [20] mm Hg, respectively) as did diastolic blood pressure (by 8 [15] and 10 [14] mm Hg, respectively). The large standard deviations reflect the myriad factors that influence BP in patients with acute STEMI, such as presence and severity of symptoms and discomfort, as well as heterogeneity in the doses of guideline-recommended medications with antihypertensive effects (such as β-blockers and angiotensin antagonists) that are used in these patients. Therefore, it is not possible to ascertain a specific BP effect for erythropoietin in the REVEAL trial.