Relationship of Hypertension and Systolic Blood Pressure With the Risk of Stroke or Bleeding in Patients With Atrial Fibrillation: The Fushimi AF Registry

Ishii, Mitsuru; Ogawa, Hisashi; Unoki, Takashi; An, Yoshimori; Iguchi, Moritake; Masunaga, Nobutoyo; Esato, Masahiro; Yuan, Chun; Tsuji, Hikari; Wada, Hiromichi; Hasegawa, Koji; Abe, Mitsuru; Akao, Masaharu

doi:10.1093/ajh/hpx094

Cited by 45 publications

(33 citation statements)

References 21 publications

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“…Data from the FUSHIMI study, which enrolled 3713 Japanese patients with NVAF, demonstrated that history of hypertension was not a predictor of ischemic stroke or major bleeding; however, uncontrolled hypertension defined as a baseline SBP ≥150 mmHg was found to be a predictor of ischemic stroke and major bleeding. 23 We also demonstrated that average SBP, which reflects sustained control of SBP, is more important than baseline SBP for predicting clinical outcome. This finding supports the theory of integrated AF management, ie the "C" of the ABC (Atrial fibrillation Better Care) pathway recommended in guidelines, which refers to cardiovascular and comorbidity risk optimization.…”

Section: Discussionmentioning

confidence: 62%

Average Systolic Blood Pressure and Clinical Outcomes in Patients with Atrial Fibrillation: Prospective Data from COOL-AF Registry

Krittayaphong

Pumprueg

Ratanasumawong

et al. 2021

CIA

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Purpose: Hypertension is associated with incident atrial fibrillation (AF) and AF-related complications. We investigated the associations between average systolic blood pressure (SBP) and outcomes in a nationwide cohort of Asian patients with non-valvular atrial fibrillation (NVAF). Patients and Methods: A multicenter nationwide registry of patients with NVAF in Thailand was conducted during 2014-2017. Clinical data, including blood pressure, were recorded at baseline and then every 6 months. Average SBP was calculated from the average of SBP from every visit. Cox regression models were used to calculate the rate of clinical outcomes of interest, ie ischemic stroke or transient ischemic attack (TIA), intracerebral hemorrhage (ICH), and all-cause death. Average SBP was categorized into three groups: <120, 120-140, and ≥140 mmHg. Results: A total of 3402 patients were included, and the mean age was 67.4±11.3 years. The mean (±SD) baseline and average SBPs were 128.5±18.5 and 128.0±13.4 mmHg, respectively. The mean follow-up duration was 25.7±10.6 months. The median rate of ischemic stroke/TIA, ICH, and all-cause death was 1.43 (1.17-1.74), 0.70 (0.52-0.92), and 3.77 (3.33-4.24) per 100 person-years, respectively. The rate of ischemic stroke/TIA and ICH was lowest in patients with average SBP <120 mmHg, and highest among those with average SBP ≥140 mmHg. The death rates were consistent with a J-curve effect, being lowest in patients with an average SBP 120-140 mmHg. Sustained SBP control is more important than the SBP from a single visit. Conclusion: Sustained control of SBP was significantly associated with a reduction in adverse clinical outcomes in patients with NVAF.

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Section: Discussionmentioning

confidence: 62%

Average Systolic Blood Pressure and Clinical Outcomes in Patients with Atrial Fibrillation: Prospective Data from COOL-AF Registry

Krittayaphong

Pumprueg

Ratanasumawong

et al. 2021

CIA

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“…Hypertension is the most common risk factor for the development of AF worldwide (34). However, it remains unclear whether SBP and DBP levels are related to the risk of stroke in AF patients (35). In the present meta-analysis, the ischemic stroke group showed significantly higher BP levels and a greater risk of ischemic stroke than the nonstroke group.…”

Section: Figurementioning

confidence: 54%

Optimized stratification of risk factors in and beyond the CHA2DS2-VASc score to differentiate the real thromboembolic risk in mainland China: a systematic review and meta-analysis

Zeng

et al. 2020

Ann Palliat Med

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Recent studies have demonstrated the limitations of the CHA 2 DS 2 -VASc score [congestive heart failure, hypertension, age (>65 years =1 point; >75 years =2 points), diabetes, and previous stroke/ transient ischemic attack (2 points), vascular disease] which lacks many of less common risk factors for stroke. Moreover, only two risk factors, gender and age, are assigned with different points according to the stratification in the CHA 2 DS 2 -VASc score. Thus, this meta-analysis was aimed to optimize the stratification of risk factors in and beyond the CHA 2 DS 2 -VASc score for patients in mainland China.

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“…(31) Similar results were evident for individuals presenting with a well-controlled hypertension. (32) Hypertension: There is no evidence in literature concerning the definition of hypertension as a cardiovascular risk factor. Usually the presence of hypertension is defined as the history of hypertension (including anti-hypertensive treatment at the time of assessment).…”

Section: Congestive Heart Failurementioning

confidence: 99%

Oral anticoagulation in patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1: a current opinion of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Council on Stroke

Sulzgruber

Waßmann

Semb

et al. 2019

European Heart Journal - Cardiovascular Pharmacotherapy

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Oral anticoagulation in patients presenting with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1 (CHA2DS2-VASc of 2 in women) remains a challenging approach in clinical practice. Therapeutic decisions need to balance the individual benefit of reducing thromboembolic risk against the potential harm due to an increase in bleeding risk in this intermediate risk patient population. Within the current opinion statement of the European Society of Cardiology working group of cardiovascular pharmacotherapy and the European Society of Cardiology council on stroke the currently available evidence on the anti-thrombotic management in patients presenting with a CHA2DS2-VASc of 1 is summarized. Easily applicable tools for a personalized refinement of the individual thromboembolic risk in patients with atrial fibrillation and a CHA2DS2-VASc score of 1 that guide clinicians through the question whether to anticoagulate or not are provided.

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Relationship of Hypertension and Systolic Blood Pressure With the Risk of Stroke or Bleeding in Patients With Atrial Fibrillation: The Fushimi AF Registry

Abstract: The incidences of stroke/SE and bleeding were higher in AF and hypertension patients with elevated SBP. UMIN Clinical Trials Registry: UMIN000005834.

Cited by 45 publications

References 21 publications

Average Systolic Blood Pressure and Clinical Outcomes in Patients with Atrial Fibrillation: Prospective Data from COOL-AF Registry

Average Systolic Blood Pressure and Clinical Outcomes in Patients with Atrial Fibrillation: Prospective Data from COOL-AF Registry

Optimized stratification of risk factors in and beyond the CHA2DS2-VASc score to differentiate the real thromboembolic risk in mainland China: a systematic review and meta-analysis

Oral anticoagulation in patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1: a current opinion of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Council on Stroke

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