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

BACKGROUND: 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. METHODS AND RESULTS: A consecutive series of outpatients with atr...

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Detalles Bibliográficos
Autores principales: Kodani, Eitaro, Atarashi, Hirotsugu, Inoue, Hiroshi, Okumura, Ken, Yamashita, Takeshi, Otsuka, Toshiaki, Tomita, Hirofumi, Origasa, Hideki, Sakurai, M., Kawamura, Y., Kubota, I., Kaneko, Y., Matsumoto, K., Ogawa, S., Aizawa, Y., Kodama, I., Watanabe, E., Koretsune, Y., Okuyama, Y., Shimizu, A., Igawa, O., Bando, S., Fukatani, M., Saikawa, T., Chishaki, A., Kato, N., Kanda, K., Kato, J., Obata, H., Aoki, M., Honda, H., Konta, Y., Hatayama, T., Abe, Y., Terata, K., Yagi, T., Ishida, A., Komatsu, T., Tachibana, H., Suzuki, H., Kamiyama, Y., Watanabe, T., Oguma, M., Itoh, M., Hirono, O., Tsunoda, Y., Ikeda, K., Kanaya, T., Sakurai, K., Sukekawa, H., Nakada, S., Itoh, T., Tange, S., Manita, M., Ohta, M., Eguma, H., Kato, R., Endo, Y., Ogino, T., Yamazaki, M., Kanki, H., Uchida, M., Miyanaga, S., Shibayama, K., Toratani, N., Kojima, T., Ichikawa, M., Saito, M., Umeda, Y., Sawanobori, T., Sohara, H., Okubo, S., Okubo, T., Tokunaga, T., Kuboyama, O., Ito, H., Kitahara, Y., Sagara, K., Satoh, T., Sugi, K., Kobayashi, Y., Higashi, Y., Katoh, T., Hirayama, Y., Matsumoto, N., Takano, M., Ikeda, T., Yusu, S., Niwano, S., Nakazato, Y., Kawano, Y., Sumiyoshi, M., Hagiwara, N., Murasaki, K., Mitamura, H., Nakagawa, S., Okishige, K., Azegami, K., Aoyagi, H., Sugiyama, K., Nishizaki, M., Yamawake, N., Watanabe, I., Ohkubo, K., Sakurada, H., Fukamizu, S., Suzuki, M., Nagahori, W., Nakamura, T., Murakawa, Y., Hayami, N., Yoshioka, K., Amino, M., Hirao, K., Yagishita, A., Ajiki, K., Fujiu, K., Imai, Y., Yamashina, A., Ishiyama, T., Sakabe, M., Nishida, K., Asanoi, H., Ueno, H., Lee, J. D., Mitsuke, Y., Furushima, H., Ebe, K., Tagawa, M., Sato, M., Morikawa, M., Yamashiro, K., Takami, K., Ozawa, T., Watarai, M., Yamauchi, M., Kamiya, H., Hirayama, H., Yoshida, Y., Murohara, T., Inden, Y., Osanai, H., Ohte, N., Goto, T., Morishima, I., Yamamoto, T., Fujii, E., Senga, M., Hayashi, H., Urushida, T., Takada, Y., Tsuboi, N., Noda, T., Hirose, T., Onodera, T., Kageyama, S., Osaka, T., Tomita, T., Shimada, K., Nomura, M., Izawa, H., Sugiura, A., Arakawa, T., Kimura, K., Mine, T., Makita, T., Mizuno, H., Kobori, A., Haruna, T., Takagi, M., Tanaka, N., Shimizu, H., Kurita, T., Motoki, K., Takeda, N., Kijima, Y., Ito, M., Nakata, A., Ueda, Y., Hirata, A., Kamakura, S., Satomi, K., Yamada, Y., Yoshiga, Y., Ogawa, H., Kimura, M., Hayano, T., Kinbara, T., Tatsuno, H., Harada, M., Kusano, K. F., Adachi, M., Yano, A., Sawaguchi, M., Yamasaki, J., Matsuura, T., Tanaka, Y., Moritani, H., Maki, T., Okada, S., Takechi, M., Hamada, T., Nishikado, A., Takagi, Y., Matsumoto, I., Soeki, T., Doi, Y., Okawa, M., Seo, H., Kitamura, S., Yamamoto, K., Akizawa, M., Kaname, N., Ando, S., Narita, S., Inou, T., Fukuizumi, Y., Saku, K., Ogawa, M., Urabe, Y., Ikeuchi, M., Harada, S., Yamabe, H., Imamura, Y., Yamanouchi, Y., Sadamatsu, K., Yoshida, K., Kubota, T., Takahashi, N., Makino, N., Higuchi, Y., Ooie, T., Iwao, T., Kitamura, K., Imamura, T., Maemura, K., Komiya, N., Hayano, M., Yoshida, H., Kumagai, K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Original Research
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079049/
https://www.ncbi.nlm.nih.gov/pubmed/27620886
http://dx.doi.org/10.1161/JAHA.116.004075
Descripción
Sumario:BACKGROUND: 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. METHODS AND RESULTS: 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 CHA (2) DS (2)‐VASc score, warfarin use, and antiplatelet use. A systolic BP of ≥136 mm Hg was an independent risk factor for thromboembolism and major hemorrhage. CONCLUSIONS: 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. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp/ctr. Unique identifier: UMIN000001569.

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