Impact of Blood Pressure Control on Thromboembolism and Major Hemorrhage in Patients With Nonvalvular Atrial Fibrillation: A Subanalysis of the J‐RHYTHM Registry. Issue 9 (September 2016)

• Record Type: Journal Article
• Authors: Kodani, Eitaro; Atarashi, Hirotsugu; Inoue, Hiroshi; Okumura, Ken; Yamashita, Takeshi; Otsuka, Toshiaki; Tomita, Hirofumi; Origasa, Hideki
• Other Names: Sakurai M. investigator.; Kawamura Y. investigator.; Kubota I. investigator.; Kaneko Y. investigator.; Matsumoto K. investigator.; Ogawa S. investigator.; Aizawa Y. investigator.; Kodama I. investigator.; Watanabe E. investigator.; Koretsune Y. investigator.; Okuyama Y. investigator.; Shimizu A. investigator.; Igawa O. investigator.; Bando S. investigator.; Fukatani M. investigator.; Saikawa T. investigator.; Chishaki A. investigator.; Kato N. investigator.; Kanda K. investigator.; Kato J. investigator.; Obata H. investigator.; Aoki M. investigator.; Honda H. investigator.; Konta Y. investigator.; Hatayama T. investigator.; Abe Y. investigator.; Terata K. investigator.; Yagi T. investigator.; Ishida A. investigator.; Komatsu T. investigator.; Tachibana H. investigator.; Suzuki H. investigator.; Kamiyama Y. investigator.; Watanabe T. investigator.; Oguma M. investigator.; Itoh M. investigator.; Hirono O. investigator.; Tsunoda Y. investigator.; Ikeda K. investigator.; Kanaya T. investigator.; Sakurai K. investigator.; Sukekawa H. investigator.; Nakada S. investigator.; Itoh T. investigator.; Tange S. investigator.; Manita M. investigator.; Ohta M. investigator.; Eguma H. investigator.; Kato R. investigator.; Endo Y. investigator.; Ogino T. investigator.; Yamazaki M. investigator.; Kanki H. investigator.; Uchida M. investigator.; Miyanaga S. investigator.; Shibayama K. investigator.; Toratani N. investigator.; Kojima T. investigator.; Ichikawa M. investigator.; Saito M. investigator.; Umeda Y. investigator.; Sawanobori T. investigator.; Sohara H. investigator.; Okubo S. investigator.; Okubo T. investigator.; Tokunaga T. investigator.; Kuboyama O. investigator.; Ito H. investigator.; Kitahara Y. investigator.; Sagara K. investigator.; Satoh T. investigator.; Sugi K. investigator.; Kobayashi Y. investigator.; Higashi Y. investigator.; Katoh T. investigator.; Hirayama Y. investigator.; Matsumoto N. investigator.; Takano M. investigator.; Ikeda T. investigator.; Yusu S. investigator.; Niwano S. investigator.; Nakazato Y. investigator.; Kawano Y. investigator.; Sumiyoshi M. investigator.; Hagiwara N. investigator.; Murasaki K. investigator.; Mitamura H. investigator.; Nakagawa S. investigator.; Okishige K. investigator.; Azegami K. investigator.; Aoyagi H. investigator.; Sugiyama K. investigator.; Nishizaki M. investigator.; Yamawake N. investigator.; Watanabe I. investigator.; Ohkubo K. investigator.; Sakurada H. investigator.; Fukamizu S. investigator.; Suzuki M. investigator.; Nagahori W. investigator.; Nakamura T. investigator.; Murakawa Y. investigator.; Hayami N. investigator.; Yoshioka K. investigator.; Amino M. investigator.; Hirao K. investigator.; Yagishita A. investigator.; Ajiki K. investigator.; Fujiu K. investigator.; Imai Y. investigator.; Yamashina A. investigator.; Ishiyama T. investigator.; Sakabe M. investigator.; Nishida K. investigator.; Asanoi H. investigator.; Ueno H. investigator.; Lee J. D. investigator.; Mitsuke Y. investigator.; Furushima H. investigator.; Ebe K. investigator.; Tagawa M. investigator.; Sato M. investigator.; Morikawa M. investigator.; Yamashiro K. investigator.; Takami K. investigator.; Ozawa T. investigator.; Watarai M. investigator.; Yamauchi M. investigator.; Kamiya H. investigator.; Hirayama H. investigator.; Yoshida Y. investigator.; Murohara T. investigator.; Inden Y. investigator.; Osanai H. investigator.; Ohte N. investigator.; Goto T. investigator.; Morishima I. investigator.; Yamamoto T. investigator.; Fujii E. investigator.; Senga M. investigator.; Hayashi H. investigator.; Urushida T. investigator.; Takada Y. investigator.; Tsuboi N. investigator.; Noda T. investigator.; Hirose T. investigator.; Onodera T. investigator.; Kageyama S. investigator.; Osaka T. investigator.; Tomita T. investigator.; Shimada K. investigator.; Nomura M. investigator.; Izawa H. investigator.; Sugiura A. investigator.; Arakawa T. investigator.; Kimura K. investigator.; Mine T. investigator.; Makita T. investigator.; Mizuno H. investigator.; Kobori A. investigator.; Haruna T. investigator.; Takagi M. investigator.; Tanaka N. investigator.; Shimizu H. investigator.; Kurita T. investigator.; Motoki K. investigator.; Takeda N. investigator.; Kijima Y. investigator.; Ito M. investigator.; Nakata A. investigator.; Ueda Y. investigator.; Hirata A. investigator.; Kamakura S. investigator.; Satomi K. investigator.; Yamada Y. investigator.; Yoshiga Y. investigator.; Ogawa H. investigator.; Kimura M. investigator.; Hayano T. investigator.; Kinbara T. investigator.; Tatsuno H. investigator.; Harada M. investigator.; Kusano K. F. investigator.; Adachi M. investigator.; Yano A. investigator.; Sawaguchi M. investigator.; Yamasaki J. investigator.; Matsuura T. investigator.; Tanaka Y. investigator.; Moritani H. investigator.; Maki T. investigator.; Okada S. investigator.; Takechi M. investigator.; Hamada T. investigator.; Nishikado A. investigator.; Takagi Y. investigator.; Matsumoto I. investigator.; Soeki T. investigator.; Doi Y. investigator.; Okawa M. investigator.; Seo H. investigator.; Kitamura S. investigator.; Yamamoto K. investigator.; Akizawa M. investigator.; Kaname N. investigator.; Ando S. investigator.; Narita S. investigator.; Inou T. investigator.; Fukuizumi Y. investigator.; Saku K. investigator.; Ogawa M. investigator.; Urabe Y. investigator.; Ikeuchi M. investigator.; Harada S. investigator.; Yamabe H. investigator.; Imamura Y. investigator.; Yamanouchi Y. investigator.; Sadamatsu K. investigator.; Yoshida K. investigator.; Kubota T. investigator.; Takahashi N. investigator.; Makino N. investigator.; Higuchi Y. investigator.; Ooie T. investigator.; Iwao T. investigator.; Kitamura K. investigator.; Imamura T. investigator.; Maemura K. investigator.; Komiya N. investigator.; Hayano M. investigator.; Yoshida H. investigator.; Kumagai K. investigator.;
• Is Part Of: Journal of the American Heart Association. Volume 5:Issue 9(2016)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2016-09
• Subjects: anticoagulation -- atrial fibrillation -- blood pressure -- hypertension -- thromboembolism; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.116.004075
• Languages: English
• ISSNs: 2047-9980

Abstract

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 CHA2 DS2 ‐VASc 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: UMIN000001569.