title: Increased bleeding risk during percutaneous coronary interventions by arterial hypertension.
abstract: OBJECTIVE
  We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown.
  
  
  METHODS
  This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI.
  
  
  RESULTS
  Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P < 0.001). Access-site bleeding occurred in 730 patients with arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P < 0.001), access-site bleeding (adjusted OR = 1.36 [1.10-1.68], P = 0.005) and non-access-site bleeding (adjusted OR = 1.42 [1.09-1.83], P = 0.008). A history of arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018).
  
  
  CONCLUSIONS
  Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Groha
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Lahmann
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Raphaela
authors.initials: R
authors.lastname: Lohaus
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cassese
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schulz-Schüpke
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kufner
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Mayer
authors.affiliation: 1.Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
authors.forename: Isabell
authors.initials: I
authors.lastname: Bernlochner
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Byrne
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fusaro
authors.affiliation: 1.Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Karl-Ludwig
authors.initials: KL
authors.lastname: Laugwitz
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Heribert
authors.initials: H
authors.lastname: Schunkert
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D062186:Arterial Pressure / Q000187:drug effects; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D016016:Proportional Hazards Models; D011677:Punctures; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: arterial hypertension; bleeding; coronary artery disease; percutaneous coronary intervention