Impact of Blood Pressure Control on Thromboembolism and Major Hemorrhage in Patients With Nonvalvular Atrial Fibrillation: A Subanalysis of the J‐RHYTHM Registry

• Published in: Journal of the American Heart Association Vol. 5; no. 9
• Main Authors: Kodani, Eitaro, Otsuka, Toshiaki, Tomita, Hirofumi, Kaneko, Y., Koretsune, Y., Okuyama, Y., Shimizu, A., Saikawa, T., Chishaki, A., Kanda, K., Aoki, M., Honda, H., Konta, Y., Hatayama, T., Komatsu, T., Tachibana, H., Suzuki, H., Kamiyama, Y., Endo, Y., Yamazaki, M., Kanki, H., Miyanaga, S., Toratani, N., Kojima, T., Tokunaga, T., Satoh, T., Kobayashi, Y., Katoh, T., Niwano, S., Kawano, Y., Hagiwara, N., Murasaki, K., Mitamura, H., Azegami, K., Sakurada, H., Suzuki, M., Nakamura, T., Yoshioka, K., Amino, M., Hirao, K., Ajiki, K., Fujiu, K., Yamashina, A., Sakabe, M., Ueno, H., Yamashiro, K., Takami, K., Ozawa, T., Yamauchi, M., Kamiya, H., Hirayama, H., Osanai, H., Yamamoto, T., Senga, M., Hayashi, H., Urushida, T., Takada, Y., Noda, T., Hirose, T., Tomita, T., Izawa, H., Mine, T., Makita, T., Haruna, T., Takagi, M., Shimizu, H., Motoki, K., Kijima, Y., Ueda, Y., Hirata, A., Yoshiga, Y., Hayano, T., Kusano, K. F., Adachi, M., Sawaguchi, M., Matsuura, T., Maki, T., Hamada, T., Nishikado, A., Takagi, Y., Soeki, T., Doi, Y., Okawa, M., Seo, H., Kitamura, S., Yamamoto, K., Akizawa, M., Ando, S., Inou, T., Ogawa, M., Ikeuchi, M., Imamura, Y., Sadamatsu, K., Yoshida, K., Higuchi, Y., Ooie, T., Iwao, T., Kitamura, K., Imamura, T., Komiya, N.
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01.09.2016; Wiley
• Subjects: Aged; anticoagulation; Antihypertensive Agents - therapeutic use; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - epidemiology; Blood Pressure; Female; Hemorrhage - epidemiology; Humans; hypertension; Hypertension - drug therapy; Hypertension - epidemiology; Hypertension - physiopathology; Japan - epidemiology; Male; Middle Aged; Odds Ratio; Original Research; Proportional Hazards Models; Prospective Studies; Registries; Risk Factors; thromboembolism; Thromboembolism - epidemiology; blood pressure; atrial fibrillation; thromboembolism; hypertension; anticoagulation
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.116.004075

Background To clarify the influence of hypertension and blood pressure (BP) control on thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J‐RHYTHM Registry was performed. Methods and Results A consecutive series of outpatients with atrial fibrillation was enrolled from 158 institutions. Of 7937 patients, 7406 with nonvalvular atrial fibrillation (70.8% men, 69.8±10.0 years) were followed for 2 years or until an event occurred. Hypertension was defined as a systolic BP ≥140 mm Hg, a diastolic BP ≥90 mm Hg, a history of hypertension, and/or antihypertensive drug use. Hypertension was an independent risk factor for major hemorrhage (hazard ratio 1.52, 95% CI 1.05–2.21, P=0.027) but not for thromboembolism (hazard ratio 1.05, 95% CI 0.73–1.52, P=0.787). When patients were divided into quartiles according to their systolic BP at the time closest to the event or at the end of follow‐up (Q1, <114; Q2, 114–125; Q3, 126–135; and Q4, ≥136 mm Hg), odds ratios for both events were significantly higher in Q4 than in Q1 (thromboembolism, odds ratio 2.88, 95% CI 1.75–4.74, P<0.001; major hemorrhage, odds ratio 1.61, 95% CI 1.02–2.53, P=0.041) after adjustment for components of CHA2DS2‐VASc score, warfarin use, and antiplatelet use. A systolic BP of ≥136 mm Hg was an independent risk factor for thromboembolism and major hemorrhage. Conclusions BP control appears to be more important than a history of hypertension and baseline BP values at preventing thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation. Clinical Trial Registration URL: http://www.umin.ac.jp/ctr. Unique identifier: UMIN000001569.