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

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

the J‐RHYTHM Registry Investigators¹  Hirofumi Tomita²  Toshiaki Otsuka³  Eitaro Kodani⁴  Hirotsugu Atarashi⁴  Hideki Origasa⁵  Ken Okumura⁶  Hiroshi Inoue⁷  Takeshi Yamashita⁸ 

[1]

[2]Department of Cardiology Hirosaki University Graduate School of Medicine Aomori Japan

[3]Department of Hygiene and Public Health Nippon Medical School Tokyo Japan

[4]Department of Internal Medicine and Cardiology Nippon Medical School Tama‐Nagayama Hospital Tokyo Japan

[5]Division of Biostatistics and Clinical Epidemiology University of Toyama Japan

[6]Saiseikai Kumamoto Hospital Kumamoto Japan

[7]Saiseikai Toyama Hospital Toyama Japan

[8]The Cardiovascular Institute Tokyo Japan

关键词: anticoagulation;    atrial fibrillation;    blood pressure;    hypertension;    thromboembolism;   

DOI  :  10.1161/JAHA.116.004075

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown