The complex interplay: How lifestyle and psychosocial factors contribute to hypertension in myocardial infarction patients-An integrated model

Abstract

INTRODUCTION: A significant proportion of acute myocardial infarction (MI) patients also suffer from hypertension (HTN), underscoring the need for effective HTN prevention and management strategies in this group. This study aims to elucidate the complex web of direct and indirect factors contributing to HTN in the context of MI. MATERIAL AND METHODS: The study utilized longitudinal data from patients aged 18-75 experiencing their first ST-segment elevation MI from five major provinces of Iran, including Tehran, Isfahan, Yazd, Gilan, and Hormozgan. HTN was the primary endpoint, with contributing factors including lifestyle, psychological factors, socioeconomic status, and comorbidities. We applied Bayesian structural equation modeling to analyze the interplay among 14 key variables influencing HTN in MI patients. RESULTS: Among the 1699 participants, 424 men (69.9) and 181 women (30.1) were identified as having HTN. Our multi-dimensional analysis revealed that increased comorbidities directly escalate blood pressure levels. Furthermore, the adoption of a healthier lifestyle characterized by sufficient physical activity, quality sleep, sexual satisfaction, non-smoking status, and a favorable dietary score, along with the enhancement of psychosocial factors such as stress management and the modification of type D personality traits and socioeconomic status can curb HTN directly and indirectly. CONCLUSION: This study integrates diverse factors into a multi-dimensional model and offers insights into new preventive avenues for HTN in MI patients. Our findings can inform strategies to mitigate HTN risk in this vulnerable population by pinpointing both direct and indirect predictors and intervention points.