Author Affiliations: Department of Medicine, University of Basel, Basel, Switzerland (Dr Krapf) (reto.krapf@ksbh.ch); and Department of Medicine, University of California, San Francisco (Dr Hulter).
To the Editor: The REVEAL (Reduction of Infarct Expansion and Ventricular Remodeling With Erythropoietin After Large Myocardial Infarction) trial reported an increased risk of death, recurrent myocardial infarction (MI), stroke, and stent thrombosis after a single dose of erythropoietin within 4 hours of reperfusion in patients with acute ST-segment elevation myocardial infarction (STEMI).1 This suggests increased arterial thrombotic risk following acute erythropoiesis-stimulating agent (ESA) treatment in patients with MI, consistent with earlier reports of ESA use for chronic anemia treatment in patients with chronic kidney disease, end-stage renal disease, and cancer.2 Since we previously suggested that the hypertensive effect of ESAs is a leading candidate for explaining their cardiovascular adverse events,3 we were interested in the authors' statement that there were no clinically meaningful differences in blood pressure (BP) among the ESA and placebo groups. Blood pressure data were reported only at 24 hours, 48 hours, 14 days, and 30 days after ESA dose (60 000 IU of epoetin alfa).
Although lower doses of epoetin (~ 3000 IU) have been reported to show no immediate hypertensive effects in humans,4 high doses (30 000 IU per day) have been reported to acutely increase arterial BP in both resting and exercising normal individuals.5 Because BP is typically measured many times during the first 24 hours after reperfusion in MI patients and because the question is important for understanding the cardiovascular outcomes, we wonder if the authors might provide BP data during the first 24 hours after ESA treatment.
Conflict of Interest Disclosures: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Hulter reported serving as a consultant and owning stock in FibroGen. Dr Krapf reported no disclosures.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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