The association between elevated admission systolic blood pressure in patients with acute coronary syndrome and favorable early and late outcomes

•In patients with acute coronary syndrome there is an inverse association between admission systolic blood pressure and cardiovascular outcomes.•The association between admission systolic blood pressure and outcome is unrelated to drug therapy.•In patients with acute coronary syndrome, elevated admission systolic blood pressure is associated with favorable early and late outcomes.•Low admission systolic blood pressure is associated with poor early and late outcomes.

In patients with acute coronary syndrome (ACS), the predictive potential of admission systolic blood pressure (SBP) on early and late outcomes is not entirely clear. We investigated the association between admission SBP in patients hospitalized for ACS and subsequent morbidity and mortality in a real world setting. The study population comprised 7645 ACS patients enrolled in the Acute Coronary Syndromes Israeli Survey (ACSIS) between 2002 and 2010. We analyzed the association between admission SBP, and the rates of 7–day and 1–year all–cause mortality and of 30–day major cardiovascular adverse events (MACE). Admission SBP was categorized as low (<110 mm Hg), normal (110–140 mm Hg), high (141–160 mm Hg), and very high (>160 mm Hg). Compared with patients with normal admission SBP, those with low SBP had a significantly increased hazard ratios (HRs) for 7–day and 1–year mortality, and MACE of 2.37, 1.92, and 1.51, respectively (all P < .001). In contrast, patients with very high admission SBP had significantly decreased HRs for 7–day and 1–year mortality, and MACE of 0.46, 0.65, and 0.84, respectively (P = .004, <.001, and .07, respectively). In patients with ACS, elevated admission SBP is associated with favorable early and late outcomes.