Controlled Level and Variability of Systolic Blood Pressure on the Risk of Thromboembolic Events in Atrial Fibrillation and Hypertension

https://doi.org/10.1016/j.amjcard.2022.06.036Get rights and content

Hypertension is an independent risk factor for thromboembolic events in patients with atrial fibrillation (AF). However, the association between blood pressure (BP) control and thromboembolic events remains under-evaluated in patients with AF. We aimed to identify the relation between BP control and the risk of ischemic stroke and systemic embolism in hypertensive patients with AF. Data on 13,712 consecutive patients with AF (9,505 with and 4,207 without hypertension) were retrospectively analyzed. The hypertensive group was divided into quartiles according to the initial BP, linearly interpolated mean BP, variability independent of the mean of the BP, and time in therapeutic range (<130 mm Hg for systolic BP [SBP] and <80 mm Hg for diastolic BP) during follow-up. The primary outcome was ischemic stroke and systemic embolism. The mean follow-up duration of the study population was median 2.7 years (interquartile range 1.1 to 4.9 years), and the median number of BP measurements was 14 (interquartile range 6 to 25) times. Strictly controlled initial and interpolated mean BP and low variability in controlled BP (variability independent of the mean) were associated with a lower risk of ischemic stroke and systemic embolism for both SBP and diastolic BP. A similar risk was observed in patients with strictly controlled SBP (time in therapeutic range under 130 mm Hg >94%) and those without hypertension. In conclusion, continuous and strict maintenance of SBP under 130 mm Hg with low variability at outpatient clinic follow-up reduces the risk of ischemic stroke and systemic embolism in patients with hypertension and AF.

Section snippets

Methods

The present study is a retrospective observational review of consecutive AF patients managed at Asan Medical Center between 2006 and 2017 (Figure 1). Patients with follow-up loss after initial presentation, no available follow-up BP measurements data, and significant mitral stenosis or mechanical valves were excluded from this analysis. Of the 13,532 patients, 9,505 patients previously diagnosed with hypertension at the time of AF diagnosis were enrolled in the hypertensive group, and 4,027

Results

Baseline characteristics of the 13,532 enrolled patients were listed in Table 1. Hypertensive patients were typically characterized by a greater proportion of older patients, male patients, and a higher rate of co-morbidities such as diabetes mellitus, vascular disease, previous history of stroke/transient ischemic attack, heart failure, and a higher CHA2DS2-VASc score. The baseline characteristics of the patients divided by the averaged SBP and DBP during the follow-up period were listed in

Discussion

The main findings in the present study were as follows: (1) initial BP at diagnosis of AF and averaged mean BP during follow-up were related to the risk of ischemic stroke and systemic embolism; (2) high variability of SBP and DBP and lower TTR during follow-up were associated with higher risk; (3) in the most strictly controlled patients (Q4 in Figure 5), the risk was similar to that of patients without hypertension.

There was no specific ideal BP value for patients with AF in the current

Disclosures

The authors have no conflicts of interest to declare.

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    This study was supported by a research grant from the Asan Institute for Life Sciences, Seoul, Korea and the Heart Institute, Asan Medical Center, Seoul, Korea: 2021T0010-1.

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