Effects of Warfarin on Blood Pressure in Men With Diabetes and Hypertension—A Longitudinal Study

Abstract

3 Vascular calcification and systolic hypertension occur in rats given high doses of warfarin-a process presumed to be related to warfarin's inhibition of vitamin K regeneration and thus low levels of active MGP. 3,4 In humans, long-term warfarin therapy is associated with increased valvular and coronary calcification seen on computed tomography 5 and increased calcium deposition on histopathologic examination of aortic valves.6 It is therefore possible that warfarin-induced arterial calcification may lead to systolic hypertension in humans as well. We recently performed a post hoc analysis of a randomized clinical trial of warfarin in atrial fibrillation and demonstrated that there was no effect on blood pressure (BP) or pulse pressure (PP) after 24 months of warfarin therapy in all trial participants.7 A subgroup analysis suggested, however, that patients with underlying hypertension or diabetes mellitus (DM) receiving warfarin might have increased systolic BP and PP compared with controls. 7 In the present study, we tested these subgroups separately and hypothesized that long-term warfarin therapy leads to increased systolic BP and PP in older men with DM and hypertension. METHODSWe performed an historical cohort study of male patients with a diagnosis of DM and hypertension who were on warfarin therapy for 3 years or longer. Patients on dialysis or receiving anticoagulation for

Anticoagulants and acute kidney injury: clinical and pathology considerations

“…Similar conclusions were reported by Dao et al [44] and Essalihi et al [45] , who also performed chronic treatment with warfarin and vitamin K. Krishnan et al [43] analyzed the Stroke Prevention in Non-Rheumatic Atrial Fibrillation (SPINAF) trial, which included 525 subjects, and they found a significant elevation in the pulse pressure of warfarin-treated patients with hypertension. However, no significant changes in BP were seen by these [42] , [43] or other authors [46] in patients receiving long-term warfarin treatment (2–3 years). This discrepancy between our data and previously published data may be explained by the duration of the treatment (acute vs. chronic) and by possible adjustment of antihypertensive drugs for better BP control in the patients.…”

The impact of warfarin on the rate of progression of aortic stiffness in hemodialysis patients: a longitudinal study

“…However, in longitudinal studies, the association between the use of warfarin and systolic hypertension, a surrogate of vascular calcification and stiffness, has not been confirmed [23,24]. In the context of the present study, we hypothesized that warfarin therapy and vitamin K deficiency results in enhanced progression of aortic stiffness.…”

“…These observations suggest that warfarin may have an adverse effect on PP in patients with increased susceptibility to vascular calcification. However, Lim et al [24] failed to show any significant changes in SBP in diabetic hypertensive patients. In our study, we did not find any significant differences in PP between groups.…”

Warfarin-Induced Calcification: Potential Prevention and Treatment Strategies

“…Moreover, the use of warfarin in these patients improved thromboembolism, but decreased the level of matrix Gla protein, which may promote the calcification of the coronary and renal arteries, thus increasing the risk of cardiovascular disease and accelerating the decline of renal function. It has been reported that warfarin may accelerate hypertension in high-risk patients, especially in those with diabetes or uncontrolled hypertension [ 30 ].…”