Impact of pre‐existing hypertension and control status before atrial fibrillation onset on cardiovascular prognosis in patients with non‐valvular atrial fibrillation: A real‐world database analysis in Japan

Abstract

Hypertension is an important risk factor for non‐valvular atrial fibrillation (NVAF) and its prognosis. However, there is no study to clarify the impact of pre‐existing hypertension and BP control status before the onset of AF on the prognosis after the onset of AF. This retrospective real‐world cohort analysis used data from the Japan Medical Data Center Co., Ltd database. The presence of NVAF and hypertension, plus the occurrence of adverse events, was based on ICD‐10 codes in the database. The primary composite AF‐related cardiovascular event end point included ischemic stroke, hemorrhagic stroke, and acute myocardial infarction. Of the 21 523 patients identified as having new‐onset NVAF between January 2005 and June 2016, 7885 had blood pressure (BP) data before the onset of NVAF available and were included in the analysis (4001 with pre‐existing hypertension and 3884 without pre‐existing hypertension). The rate of primary composite end point events was 10.3 and 4.4 per 1000 patient‐years in patients with and without hypertension, respectively (P < .001). In addition, lower systolic BP (<120 mm Hg) before the onset of NVAF was associated with a lower incidence of cardiovascular events after the development of NVAF (P < .001). This highlights the importance of earlier and tighter 24‐hour BP control before the onset of NVAF in patients with hypertension, not only for reducing the occurrence of new‐onset of NVAF, but also for reducing both hemorrhagic and ischemic cardiovascular events after the onset of NVAF.

Assessment of a new algorithm to detect atrial fibrillation in home blood pressure monitoring device among healthy adults and patients with atrial fibrillation

“…2 Hypertension is one of the major etiologic factors for coexisting AF, and blood pressure (BP) control is important for the prevention of AF. 3,4 Aging can increase the risk of developing both hypertension and AF, and coexisting AF and hypertension can increase stroke risk. 5 A new method for diagnosing AF in hypertensive patients is thus urgently needed.…”

High prevalence of masked uncontrolled morning hypertension in elderly non‐valvular atrial fibrillation patients: Home blood pressure substudy of the ANAFIE Registry

“…As in the present substudy, based on the average of morning and evening home blood pressure, HONEST study patients had insufficient control of morning H‐SBP. Patients with severe masked hypertension in the HONEST study were older, had cardiovascular comorbidities, and lower BMI 8 . A Finnish study evaluating similar associations also found that older age and current smoking were independent predictors of masked hypertension 49 .…”

The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

“…The HOPE Asia Network has published a number of papers on important Asia‐specific topics in hypertension . This Asia‐specific issue of the Journal of Clinical Hypertension provides an important resource including original research and review articles on the management of hypertension from a variety of Asian viewpoints, including topics such as central BP, environmental factors, comorbidities such as diabetes, atrial fibrillation, heart failure, and dementia, recent Asian guidelines and so forth . This issue also includes reports from twelve countries/regions in Asia to help define and highlight the current status of hypertension, its management, and their initiatives.…”