Impact of Blood Pressure Control on Thromboembolism and Major Hemorrhage in Patients With Nonvalvular Atrial Fibrillation: A Subanalysis of the J‐RHYTHM Registry
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Published:2016-09
Issue:9
Volume:5
Page:
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ISSN:2047-9980
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Container-title:Journal of the American Heart Association
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language:en
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Short-container-title:JAHA
Author:
Kodani Eitaro1, Atarashi Hirotsugu1, Inoue Hiroshi2, Okumura Ken3, Yamashita Takeshi4, Otsuka Toshiaki5, Tomita Hirofumi6, Origasa Hideki7, Sakurai M., Kawamura Y., Kubota I., Kaneko Y., Matsumoto K., Ogawa S., Aizawa Y., Kodama I., Watanabe E., Koretsune Y., Okuyama Y., Shimizu A., Igawa O., Bando S., Fukatani M., Saikawa T., Chishaki A., Kato N., Kanda K., Kato J., Obata H., Aoki M., Honda H., Konta Y., Hatayama T., Abe Y., Terata K., Yagi T., Ishida A., Komatsu T., Tachibana H., Suzuki H., Kamiyama Y., Watanabe T., Oguma M., Itoh M., Hirono O., Tsunoda Y., Ikeda K., Kanaya T., Sakurai K., Sukekawa H., Nakada S., Itoh T., Tange S., Manita M., Ohta M., Eguma H., Kato R., Endo Y., Ogino T., Yamazaki M., Kanki H., Uchida M., Miyanaga S., Shibayama K., Toratani N., Kojima T., Ichikawa M., Saito M., Umeda Y., Sawanobori T., Sohara H., Okubo S., Okubo T., Tokunaga T., Kuboyama O., Ito H., Kitahara Y., Sagara K., Satoh T., Sugi K., Kobayashi Y., Higashi Y., Katoh T., Hirayama Y., Matsumoto N., Takano M., Ikeda T., Yusu S., Niwano S., Nakazato Y., Kawano Y., Sumiyoshi M., Hagiwara N., Murasaki K., Mitamura H., Nakagawa S., Okishige K., Azegami K., Aoyagi H., Sugiyama K., Nishizaki M., Yamawake N., Watanabe I., Ohkubo K., Sakurada H., Fukamizu S., Suzuki M., Nagahori W., Nakamura T., Murakawa Y., Hayami N., Yoshioka K., Amino M., Hirao K., Yagishita A., Ajiki K., Fujiu K., Imai Y., Yamashina A., Ishiyama T., Sakabe M., Nishida K., Asanoi H., Ueno H., Lee J. D., Mitsuke Y., Furushima H., Ebe K., Tagawa M., Sato M., Morikawa M., Yamashiro K., Takami K., Ozawa T., Watarai M., Yamauchi M., Kamiya H., Hirayama H., Yoshida Y., Murohara T., Inden Y., Osanai H., Ohte N., Goto T., Morishima I., Yamamoto T., Fujii E., Senga M., Hayashi H., Urushida T., Takada Y., Tsuboi N., Noda T., Hirose T., Onodera T., Kageyama S., Osaka T., Tomita T., Shimada K., Nomura M., Izawa H., Sugiura A., Arakawa T., Kimura K., Mine T., Makita T., Mizuno H., Kobori A., Haruna T., Takagi M., Tanaka N., Shimizu H., Kurita T., Motoki K., Takeda N., Kijima Y., Ito M., Nakata A., Ueda Y., Hirata A., Kamakura S., Satomi K., Yamada Y., Yoshiga Y., Ogawa H., Kimura M., Hayano T., Kinbara T., Tatsuno H., Harada M., Kusano K. F., Adachi M., Yano A., Sawaguchi M., Yamasaki J., Matsuura T., Tanaka Y., Moritani H., Maki T., Okada S., Takechi M., Hamada T., Nishikado A., Takagi Y., Matsumoto I., Soeki T., Doi Y., Okawa M., Seo H., Kitamura S., Yamamoto K., Akizawa M., Kaname N., Ando S., Narita S., Inou T., Fukuizumi Y., Saku K., Ogawa M., Urabe Y., Ikeuchi M., Harada S., Yamabe H., Imamura Y., Yamanouchi Y., Sadamatsu K., Yoshida K., Kubota T., Takahashi N., Makino N., Higuchi Y., Ooie T., Iwao T., Kitamura K., Imamura T., Maemura K., Komiya N., Hayano M., Yoshida H., Kumagai K.,
Affiliation:
1. Department of Internal Medicine and Cardiology, Nippon Medical School, Tama‐Nagayama Hospital, Tokyo, Japan 2. Saiseikai Toyama Hospital, Toyama, Japan 3. Saiseikai Kumamoto Hospital, Kumamoto, Japan 4. The Cardiovascular Institute, Tokyo, Japan 5. Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan 6. Department of Cardiology, Hirosaki University Graduate School of Medicine, Aomori, Japan 7. Division of Biostatistics and Clinical Epidemiology, University of Toyama, Japan
Abstract
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.
Methods and Results
A consecutive series of outpatients with atrial fibrillation was enrolled from 158 institutions. Of 7937 patients, 7406 with nonvalvular atrial fibrillation (70.8% men, 69.8±10.0 years) were followed for 2 years or until an event occurred. Hypertension was defined as a systolic
BP
≥140 mm Hg, a diastolic
BP
≥90 mm Hg, a history of hypertension, and/or antihypertensive drug use. Hypertension was an independent risk factor for major hemorrhage (hazard ratio 1.52, 95%
CI
1.05–2.21,
P
=0.027) but not for thromboembolism (hazard ratio 1.05, 95%
CI
0.73–1.52,
P
=0.787). When patients were divided into quartiles according to their systolic
BP
at the time closest to the event or at the end of follow‐up (Q1, <114; Q2, 114–125; Q3, 126–135; and Q4, ≥136 mm Hg), odds ratios for both events were significantly higher in Q4 than in Q1 (thromboembolism, odds ratio 2.88, 95%
CI
1.75–4.74,
P
<0.001; major hemorrhage, odds ratio 1.61, 95%
CI
1.02–2.53,
P
=0.041) after adjustment for components of
CHA
2
DS
2
‐
VAS
c score, warfarin use, and antiplatelet use. A systolic
BP
of ≥136 mm Hg was an independent risk factor for thromboembolism and major hemorrhage.
Conclusions
BP
control appears to be more important than a history of hypertension and baseline
BP
values at preventing thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation.
Clinical Trial Registration
URL
:
http://www.umin.ac.jp/ctr
. Unique identifier:
UMIN
000001569.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
52 articles.
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