title: Blood pressure control and stroke or bleeding risk in anticoagulated patients with atrial fibrillation: Results from the ROCKET AF Trial.
abstract: We conducted a retrospective analysis examining the association between systolic blood pressure (SBP) or hypertension bracket and stroke risk in patients with atrial fibrillation (AF).
  
  
  
  The study included 14,256 anticoagulated patients in the ROCKET AF trial. Cox proportional hazards models were used to compare the risk of adverse outcomes by European Society of Cardiology hypertension bracket and screening SBP.
  
  
  
  In total, 90.5% of patients had hypertension (55.8% controlled, 34.6% uncontrolled). The adjusted risk of stroke or systemic embolism (SE) increased significantly for every 10-mm Hg increase in screening SBP (hazard ratio [HR] 1.07, 95% CI 1.02-1.13). There was a trend toward an increased adjusted risk of stroke or SE in patients with controlled (HR 1.22, 95% CI 0.89-1.66) and uncontrolled hypertension (HR 1.42, 95% CI 1.03-1.95) (P = .06). In contrast, the adjusted risk of major bleeding was similar between hypertensive brackets and did not vary significantly by screening SBP. The benefit of rivaroxaban versus warfarin in preventing stroke or SE was consistent among patients regardless of SBP (P interaction = .69).
  
  
  
  In a trial of anticoagulated patients with AF, increasing screening SBP was independently associated with stroke and SE, and one-third of patients had uncontrolled hypertension. The relative effectiveness and safety of rivaroxaban versus warfarin were consistent across all levels of screening SBP. A single SBP may be an important factor in reducing the overall risk of stroke and SE in anticoagulated patients with AF.
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. Electronic address: sreekanth.vemulapalli@duke.edu.
authors: Sreekanth
authors: S
authors: Vemulapalli
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Anne S
authors: AS
authors: Hellkamp
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: W Schuyler
authors: WS
authors: Jones
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Jonathan P
authors: JP
authors: Piccini
authors: Stanford University, Stanford, CA.
authors: Kenneth W
authors: KW
authors: Mahaffey
authors: University of Cincinnati, Cincinnati, OH.
authors: Richard C
authors: RC
authors: Becker
authors: University of Western Australia, Crawley, Perth, Australia.
authors: Graeme J
authors: GJ
authors: Hankey
authors: Bayer HealthCare Pharmaceuticals, Whippany, NJ.
authors: Scott D
authors: SD
authors: Berkowitz
authors: Janssen Research & Development, Raritan, NJ.
authors: Christopher C
authors: CC
authors: Nessel
authors: Department of Cardiovascular Medicine, University Hospital of Münster, Münster, Germany.
authors: Günter
authors: G
authors: Breithardt
authors: Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors: Daniel E
authors: DE
authors: Singer
authors: University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors: Keith A A
authors: KA
authors: Fox
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Manesh R
authors: MR
authors: Patel
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001794:Blood Pressure; D004617:Embolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012306:Risk; D000069552:Rivaroxaban / Q000627:therapeutic use; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069552:Rivaroxaban