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

Kodani, Eitaro; Atarashi, Hirotsugu; Inoue, Hiroshi; Okumura, Ken; Yamashita, Takeshi; Otsuka, Toshiaki; Tomita, Hirofumi; Origasa, Hideki; Sakurai, Minoru; Kawamura, Y.; Kubota, Isao; Kaneko, Yoshiaki; Matsumoto, Kazuo; Ogawa, Satoshi; Aizawa, Yoshifusa; Kodama, Itsuo; Watanabe, Eiichi; Koretsune, Yukihiro; Okuyama, Yuji; Shimizu, Akihiko; Igawa, Osamu; Bando, Shigenobu; Fukuda, Masahiko; Saikawa, Tetsunori; Chishaki, Akiko; Kato, Nozomi; Kanda, Katsuya; Kato, John-David; Obata, Hiroaki; Aoki, Masatoshi; Honda, Hiroto; Konta, Yoshiyuki; Hatayama, Toru; Abe, Yukihiko; Terata, Ken; Yagi, Takahide; Ishida, Akihiko; Kubo, Takashi; Tachibana, Hideaki; Suzuki, Hidenori; Kamiyama, Yoshiyuki; Watanabe, Tomonori; Oguma, Masaki; Itoh, Masatoshi; Hirono, Osamu; Tsunoda, Yuichi; Ikeda, Kenichi; Kanaya, Tohru; Sakurai, Kenzo; Sukekawa, Hiroyasu; Nakada, Seigo; Itoh, Taihei; Tange, Shoichi; Manita, Mamoru; Ohta, Mutsuko; Eguma, Hiromi; Kato, Ryuichi; Endo, Yoshiko; Ogino, Tadayoshi; Yamazaki, Masahiro; Kanki, Hideaki; Uchida, Mio; Miyanaga, Satoru; Shibayama, Kentaro; Toratani, N.; Kojima, Toshiaki; Ichikawa, Mari; Saito, Makoto; Umeda, Yuji; Sawanobori, Takao; Sohara, Hiroshi; Okubo, Setsuya; Ōkubo, Tomoyuki; Tokunaga, Tohru; Katoh, Osamu; Ito, Hiroshi; Kitahara, Younosuke; Sagara, Koichi; Sakurai, Toshihiko; Sugi, Kaoru; Kobayashi, Yoshio; Higashi, Yukihito; Katoh, Takahiko; Hirayama, Yudai; Matsumoto, Naoya; Takano, Makoto; Ikeda, Takanori; Yusu, Satoru; Niwano, Shinichi; Nakazato, Yuji; Kawano, Yuhei; Sumiyoshi, Masataka; Hagiwara, Nobuhisa; Murasaki, Kagari; Mitamura, Hideo; Nakagawa, Shunki; Okishige, Kaoru; Azegami, Kouji; Aoyagi, Haruhiko; Sugiyama, Kazutoshi; Nishizaki, Mitsuhiro; Yamawake, Noriyoshi; Watanabe, Ichiro; Ohkubo, Kimie; Sakurada, Harumizu; Fukamizu, Seiji; Suzuki, Makoto; Nagahori, Wataru; Nakamura, Tsukasa; Murakawa, Yuji; Hayami, Noriyuki; Yoshioka, Kazuhiro; Amino, Mari; Hirao, K.; Yagishita, Atsuhiko; Ajiki, Kohsuke; Fujiu, Katsuhito; Imai, Yutaka; Yamashina, Akira; Ishiyama, Taizou; Sakabe, Masao; Nishida, Keiya; Asanoi, Hidetsugu; Ueno, Hiroshi; Lee, J. D.; Mitsuke, Yasuhiko; Furushima, Hiroshi; Ebe, Katsuya; Tagawa, Minoru; Sato, Miho; Morikawa, Mayuko; Yamashiro, Kazuo; Takami, Koji; Ozawa, Tadashi; Watarai, Masato; Yamauchi, Masaki; Kamiya, Hiroki; Hirayama, Hiroyoshi; Yoshida, Yoshitaro; Murohara, Toyoaki; Inden, Yasuya; Osanai, Hiroyuki; Ohte, Nobuyuki; Goto, T; Morishima, Itsuro; Yamamoto, Takashi; Fujii, Eitaro; Senga, Michiharu; Hayashi, Hidemori; Urushida, Tsuyoshi; Takada, Yoshiaki; Tsuboi, Nobuyuki; Noda, Takashi; Hirose, Toyoki; Onodera, Tomoya; Kageyama, Shinji; Osaka, Takafumi; Tomita, Takeshi; Shimada, Kazuyuki; Nomura, Miki; Izawa, Hideo; Sugiura, Akira; Arakawa, Tomoharu; Kimura, Kenjiro; Mine, Takanao; Makita, Toshinori; Mizuno, Hiroyuki; Kobori, Atsushi; Haruna, Tetsuya; Takagi, Masahito; Tanaka, Noriko; Shimizu, Hiroaki; Kurita, Takashi; Motoki, Koichiro; Takeda, Norifumi; Kijima, Yasufumi; Ito, Masahiro; Nakata, Atsuyuki; Ueda, Yôko; Hirata, Akio; Kamakura, Shiro; Sato, Kazuhiro; Yamada, Yoko; Yoshiga, Yasuhiro; Ogawa, Hisashi; Kimura, Masaaki; Hayano, Takashi; Kinbara, Takeshi; Tatsuno, Hiroya; Harada, Masahiko; Kusano, Kuninori; Adachi, Masaki; Yano, Akemi; Sawaguchi, Makoto; Yamasaki, Junichi; Matsuura, Tomomi; Tanaka, Yoshihiro; Moritani, Hisato; Maki, Takeshi; Okada, Sadanori; Takechi, Mineki; Hamada, Takashi; Nishikado, Akiyoshi; Takagi, Yuichiro; Matsumoto, Ichiro; Soeki, Takeshi; Doi, Yoshinori; Okawa, Makoto; Seo, Hye Mi; Kitamura, S; Yamamoto, Koujiro; M, Akizawa; Kaname, Noriyoshi; Ando, Shin-ichi; Narita, Sumito; Inou, Tetsuji; Fukuizumi, Yutaka; Saku, Keijirou; Ogawa, Masaya; Urabe, Yoji; Ikeuchi, Mayumi; Harada, Shoko; Yamabe, Hiroshige; Imamura, Yusuke; Yamanouchi, Yoshinori; Sadamatsu, Kenji; Yoshida, Kōji; Kubota, Tomoki; Takahashi, Naohiko; Makino, Nobuhiko; Higuchi, You; Ooie, Tatsuhiko; Iwao, Tetsu; Kïtamura, Kazuo; Imamura, Teruhiko; Maemura, Koji; Komiya, Norihiro; Hayano, Motonobu; Yoshida, Haruhiko; Kumagai, Koji

doi:10.1161/jaha.116.004075

Cited by 52 publications

(53 citation statements)

References 36 publications

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“…Hypertension is also a major risk for stroke in patients with AF, and patients with asymptomatic AF with hypertension have a high stroke risk. Increased BP is associated with cardiovascular events in patients with AF . Thus, the necessary control of home BP could be greatly aided by the use of a home BP monitor.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic accuracy of a new algorithm to detect atrial fibrillation in a home blood pressure monitor

Kabutoya

Imai

Hoshide

2017

J of Clinical Hypertension

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The authors evaluated a new algorithm for detecting atrial fibrillation (AF) using a home blood pressure monitor. Three serial blood pressure values were measured by the monitor in 16 patients with AF and 20 patients with sinus rhythm. The authors defined "monitor AF in irregular pulse peak (IPP) 25" as follows: (1) IPP: |interval of pulse peak − the average of the interval of the pulse peak| ≥ the average of the interval of the pulse peak ×25%; (2) irregular heart beat: beats of IPP ≥ total pulse ×20%; and (3) monitor AF: two or more irregular heart beats of the three blood pressure measurements. Cutoff IPP values were set at 20% (IPP20) and 15% (IPP15). The monitor's AF specificity was 1.0 in IPP25, IPP20, and IPP15, and its sensitivity was 0.88 in IPP25, 0.94 in IPP20, and 1.0 in IPP15. The new algorithm had high diagnostic accuracy for detecting AF and a low false-positive rate. | INTRODUCTIONAtrial fibrillation (AF) is not only a major risk factor for stroke, it also causes heart failure and cardiovascular death.1-4 AF is a common disease and the prevalence of AF increases with age. 2,[5][6][7] Patients with paroxysmal AF have a stroke risk that is similar to that of patients with persistent AF. 8 However, paroxysmal AF is often not detected by standard 12-lead electrocardiography (ECG), as was shown both in patients who have undergone pacemaker implantation 9 and those with cryptogenic stroke who have received an implantable loop recorder. 10Pulse self-examination is useful to detect AF, 11 but paroxysmal AF is often asymptomatic. 12Hypertension is an important risk factor for the onset of AF. 13The causes of the onset of AF are an increase in the stress of the left atrium and autonomic nervous abnormality. 14,15 An increase in the afterload caused by hypertension causes left atrial hypertrophy and fibrosis, which are related to AF. It has been shown that a reduction in blood pressure (BP) results in a decrease in the incidence of AF. 16Two studies revealed that home BP had a higher predictive value for cardiovascular events than office BP. the specificity values were 80% to 90%, 21-24 and the agreement between pulse rate and heart rate was not examined simultaneously. In the present study, we confirmed the correlation between the interval of the pulse wave and QRS wave, and we evaluated a new algorithm for the detection of AF by a home BP monitor. | METHODS | PatientsWe enrolled 16 patients with AF and 20 outpatients with sinus rhythm. Findings from the ECG showed AF during all three BP measurements in the patients with AF and showed sinus rhythm during all three measurements in the 20 patients with sinus rhythm. | Pulse wave analysis and ECGFor each patient, three BP measurements were taken after the patient had rested for ≥5 minutes in the lying position and with at least 30 seconds between measurements, using a validated home BP monitor (UA-1020, A&D). 25 The three BPs were measured by cuff inflation to

show abstract

Section: Discussionmentioning

confidence: 99%

“…Increased BP is associated with cardiovascular events in patients with AF. 33 Thus, the necessary control of home BP could be greatly aided by the use of a home BP monitor.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of a new algorithm to detect atrial fibrillation in a home blood pressure monitor

Kabutoya

Imai

Hoshide

2017

J of Clinical Hypertension

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“…Артериальная гипертония (АГ) способствует возникновению первого и повторных эпизодов ФП [1,17], а при неконтролируемом уровне АД у больных МА увеличивается риск развития как инсультов, так и кровотечений [1,47]. Ввиду высокой распространенности повышенного АД наличие АГ обусловливает значительное число случаев ФП и ИМ; дополнительный популяционный риск, связанный ОБЗОРЫ § с АГ, для этих состояний составляет 13,5 и 18 % соответственно [48,49].…”

Section: артериальная гипертонияunclassified

Risk of Coronary Events in Atrial Fibrillation

Кобалава

Лазарев

2020

Kardiologiia

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It has been established that cardiovascular events due to coronary heart disease are highly prevalent in the population of patients with atrial fibrillation. In this review, pathophysiologic mechanisms explaining this association are detailed along with supporting epidemiological evidence. Various methods for the prediction and prevention of coronary events in atrial fibrillation are iscussed, including modification of shared risk factors, antithrombotic therapy and selection of the optimal direct oral anticoagulant in terms of favourable influence on ischemic cardiac outcomes.

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“…High blood pressure promotes the development and recurrence of AF [26,27]. Furthermore, untreated hypertension enhances stroke and bleeding risk in AF patients [27,28]. Due to the high prevalence in the general population, hypertension bears substantial relevance as a risk factor for AF development, as expressed by a population-attributable risk (PAR) of 13.5% [13,29].…”

Section: Atrial Fibrillation Myocardial Infarction Heart Failure Anmentioning

confidence: 99%

The imminent epidemic of atrial fibrillation and its concomitant diseases – Myocardial infarction and heart failure - A cause for concern

Börschel¹,

Schnabel²

2019

International Journal of Cardiology

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Atrial fibrillation (AF) is increasingly common in the general population. It often coincides with myocardial infarction (MI) and heart failure (HF) which are also diseases in older adults. All three conditions share common cardiovascular risk factors. While hypertension and obesity are central risk factors for all three diseases, smoking and diabetes appear to have less impact on AF. To date, age is the single most important risk factor for AF in the general population. Further, epidemiological studies suggest a strong association of AF to MI and HF. The underlying pathophysiological mechanisms are complex and not fully understood. Both MI and HF can trigger development of AF, mainly by promoting structural and electrical atrial remodeling. On the other hand, AF facilitates HF and MI development via multiple mechanisms, resulting in a vicious circle of cardiac impairment and adverse cardiovascular prognosis. Consequently, to prevent and treat the coincidence of AF and HF or MI a strict optimization of cardiovascular risk factors is required.

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

Abstract: on behalf of the J-RHYTHM Registry Investigators* 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.

Cited by 52 publications

References 36 publications

Diagnostic accuracy of a new algorithm to detect atrial fibrillation in a home blood pressure monitor

Diagnostic accuracy of a new algorithm to detect atrial fibrillation in a home blood pressure monitor

Risk of Coronary Events in Atrial Fibrillation

The imminent epidemic of atrial fibrillation and its concomitant diseases – Myocardial infarction and heart failure - A cause for concern

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