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When Heart Is in Crisis, High Blood Pressure a Good Sign
Date:3/23/2010

be a marker for patients with better cardiovascular reserves," Fonarow said. "It suggests that those patients who can engender a very high response may have less severe disease or a more intact neuro-hormonal system."

But the results do not indicate that high blood pressure in such cases can be ignored, Fonarow said. "It should not be taken as saying that they don't need treatment," he said. "Patients who were treated for high blood pressure before release, with drugs such as ACE inhibitors and beta blockers that lower blood pressure, did better."

The study does show the need for worry about people in the ICU with lower blood pressures, Fonarow said. "It highlights that they are at much greater risk," he said. "Those hospitalized with blood pressure below 128 need to be followed more closely."

A study led by Dr. Kim A. Eagle, director of the Cardiovascular Center at the University of Michigan, predicted such an effect for people with acute coronary syndromes several years ago, Eagle said.

"We reasoned that a patient with very low pressure was in shock or at risk of being in shock, with very little in cardiovascular reserves," he said. "There is very little room for error in cardiac function."

Blood pressure can indicate how much cardiovascular reserve a person has, Eagle said. "If someone is in acute stress, having a heart attack, and can generate acute hypertension [high blood pressure], he is in good shape," he said.

The study raises the question of "how hard should we work at lowering blood pressure in such cases," Eagle said. "Probably it should be normalized, but we don't want to go beyond that. We don't want to put the patient into acute stress."

Dr. Manesh Patel, an assistant professor of medicine at Duke University, said that it's important to remember that the study looked at "a very special group."

"They're in a very high-risk situation," Patel said. "Blood pressure is a measu
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