Impact of Blood Pressure Control on Thromboembolism and Major Hemorrhage in Patients With Nonvalvular Atrial Fibrillation: A Subanalysis of the J‐RHYTHM Registry
Authors: Kodani Eitaro , Atarashi Hirotsugu , Inoue Hiroshi , Okumura Ken , Yamashita Takeshi , Otsuka Toshiaki , Tomita Hirofumi , Origasa Hideki , 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. 
Published: September 2016

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.