Stroke prevention in patients with atrial fibrillation: The diagnosis and management of hypertension by specialists

Abstract

BACKGROUND: Hypertension is common in patients with atrial fibrillation (AF) and is an important cause of stroke. OBJECTIVES: To determine how effectively hypertension is managed among specialist-treated outpatients with AF. METHODS: Investigators reviewed the charts of patients with a diagnosis of AF cared for by medical specialists to determine the change in blood pressure, patterns of antihypertensive drug use and the role of the specialist in the management of hypertension. RESULTS: Of 209 patients with AF, 118 had a history of hypertension or an office blood pressure greater than 140/90 mmHg. Blood pressure was measured at 73% of all visits. Hypertension was identified as an important problem in 57% of patients and antihypertensive therapy was either initiated or suggested in 77%. One year after the initial specialist visit, systolic blood pressure was significantly lower (140±20 mmHg at one year versus 148±23 mmHg initially; P=0.015); however, there was no change in diastolic blood pressure (80±12 mmHg at one year versus 81±16 mmHg initially; P=0.602) and only 50% of patients had a blood pressure less than 140/90 mmHg. In contrast, the percentage of patients receiving warfarin increased from 46% to 78% (P=0.0001). CONCLUSIONS: In patients treated by specialists for AF, systolic blood pressure is significantly reduced during follow-up; however, 50% of patients continue to have suboptimal blood pressure control. In many patients, hypertension is not identified as an important comorbid illness and antihypertensive therapy is neither recommended nor initiated by the specialist. Greater specialist involvement in the identification and treatment of hypertension in patients with AF could lead to an important, additional reduction in stroke.

Comparison of dabigatran versus warfarin in diabetic patients with atrial fibrillation: Results from the RE-LY trial

“…Randomized clinical trials have previously demonstrated improved outcomes in diabetic patients with a better blood pressure (BP) control, especially at systolic BP treatment goal of 130 to 135 mm Hg [35,36]. However; in RE-LY, 1014 (24%) and 1918 (45%) patients with DM had a systolic blood pressure of more than 140 mm Hg and 130 mm Hg, respectively suggesting that improved diagnosis and management of hypertension could be an important, additional means of stroke prevention among patients with AF and DM [37].…”

Hypertension in Middle Eastern Arab and South Asian Patients with Atrial Fibrillation

“…[ 21 22 23 ] The characteristics of patients as reported in these studies are summarized in Table 4 . [ 20 21 24 25 26 27 28 29 30 31 ] The mean age of patients with AF in studies conducted in different regions have ranged from 64 years to 82 years,[ 20 21 22 23 24 25 26 27 28 29 30 31 32 ] whereas the patients in both groups of this study were younger, i.e., 52 and 63 years old, with comparable mean BMI (29 and 32 kg/m 2 ) to that reported in the published data (range of 25-32 kg/m 2 ) as shown in Table 4 . Smoking among patients with AF ranged from 5.5% in European subjects[ 20 ] to 16% in the Japanese counterparts,[ 26 ] while the percentages in the present study varied between the two groups, i.e., 8% and 15.1%.…”

The unappreciated importance of blood pressure in recent and older atrial fibrillation trials

“…In a Canadian study, the authors reviewed the patient charts of four electrophysiologists, three cardiologists, and six internists, working in the same University hospital [65]. Although important for the proper conduction of these trials, this may result in suboptimal attention to common conditions like hypertension.…”