title: Blood pressure levels and bleeding events during antithrombotic therapy: the Bleeding with Antithrombotic Therapy (BAT) Study.
abstract: OBJECTIVE
  A prospective, multicenter, observational cohort study was conducted to clarify the association between major bleeding events and blood pressure (BP) levels during follow-up before development of bleeding events in antithrombotic users.
  
  
  METHODS
  A total of 4009 patients taking oral antithrombotic agents for cardiovascular or cerebrovascular diseases (2728 men, 69+/-10 years old) were followed. Changes in systolic and diastolic BPs between entry and the last clinic visit before intracranial hemorrhage (ICH) or extracranial hemorrhage were assessed.
  
  
  RESULTS
  Over a median follow-up of 19 months, ICH developed in 31 patients and extracranial hemorrhage developed in 77. Entry BP levels were similar among patients with ICH, those with extracranial hemorrhage, and those without hemorrhagic events. Both systolic BP and diastolic BP were relatively high during follow-up as compared with the levels at entry in patients with ICH, whereas they showed plateaus in patients with extracranial hemorrhage and patients without hemorrhagic events. Average systolic BP levels between 1 and 6 months (hazard ratio, 1.45; 95% CI, 1.08 to 1.92 per 10-mm Hg increase) and between 7 and 12 months (hazard ratio, 1.47; 95% CI, 1.05 to 2.01) as well as average diastolic BP levels between 7 and 12 months (hazard ratio, 2.05; 95% CI, 1.15 to 3.62) were independently associated with development of ICH after adjustment for established ICH predictors. The optimal cutoff BP level to predict impending risk of ICH was >or=130/81 mm Hg using receiver operating characteristic curve analysis.
  
  
  CONCLUSIONS
  An increase in BP levels during antithrombotic medication was positively associated with development of ICH, suggesting the importance of adequate BP control for avoiding ICH. BP levels did not appear to be associated with extracranial hemorrhage.
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. toyoda@hsp.ncvc.go.jp
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yasaka
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Uchiyama
authors.forename: Takehiko
authors.initials: T
authors.lastname: Nagao
authors.forename: Jun
authors.initials: J
authors.lastname: Gotoh
authors.forename: Ken
authors.initials: K
authors.lastname: Nagata
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Koretsune
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Kazunori
authors.initials: K
authors.lastname: Iwade
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D005343:Fibrinolytic Agents