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



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.



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.



URL: http://www.umin.ac.jp/ctr. Unique identifier: UMIN000001569.
Department of Internal Medicine and Cardiology, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan kodani@nms.ac.jp.
Eitaro
E
Kodani
Department of Internal Medicine and Cardiology, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan.
Hirotsugu
H
Atarashi
Saiseikai Toyama Hospital, Toyama, Japan.
Hiroshi
H
Inoue
Saiseikai Kumamoto Hospital, Kumamoto, Japan.
Ken
K
Okumura
The Cardiovascular Institute, Tokyo, Japan.
Takeshi
T
Yamashita
Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.
Toshiaki
T
Otsuka
Department of Cardiology, Hirosaki University Graduate School of Medicine, Aomori, Japan.
Hirofumi
H
Tomita
Division of Biostatistics and Clinical Epidemiology, University of Toyama, Japan.
Hideki
H
Origasa
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology*; D001794:Blood Pressure; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology*
D000959:Antihypertensive Agents
anticoagulation; atrial fibrillation; blood pressure; hypertension; thromboembolism