1. Impact of Blood Pressure Control on Thromboembolism and Major Hemorrhage in Patients With Nonvalvular Atrial Fibrillation: A Subanalysis of the J‐RHYTHM Registry
- Author
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Eitaro Kodani, Hirotsugu Atarashi, Hiroshi Inoue, Ken Okumura, Takeshi Yamashita, Toshiaki Otsuka, Hirofumi Tomita, Hideki Origasa, M. Sakurai, Y. Kawamura, I. Kubota, Y. Kaneko, K. Matsumoto, S. Ogawa, Y. Aizawa, I. Kodama, E. Watanabe, Y. Koretsune, Y. Okuyama, A. Shimizu, O. Igawa, S. Bando, M. Fukatani, T. Saikawa, A. Chishaki, N. Kato, K. Kanda, J. Kato, H. Obata, M. Aoki, H. Honda, Y. Konta, T. Hatayama, Y. Abe, K. Terata, T. Yagi, A. Ishida, T. Komatsu, H. Tachibana, H. Suzuki, Y. Kamiyama, T. Watanabe, M. Oguma, M. Itoh, O. Hirono, Y. Tsunoda, K. Ikeda, T. Kanaya, K. Sakurai, H. Sukekawa, S. Nakada, T. Itoh, S. Tange, M. Manita, M. Ohta, H. Eguma, R. Kato, Y. Endo, T. Ogino, M. Yamazaki, H. Kanki, M. Uchida, S. Miyanaga, K. Shibayama, N. Toratani, T. Kojima, M. Ichikawa, M. Saito, Y. Umeda, T. Sawanobori, H. Sohara, S. Okubo, T. Okubo, T. Tokunaga, O. Kuboyama, H. Ito, Y. Kitahara, K. Sagara, T. Satoh, K. Sugi, Y. Kobayashi, Y. Higashi, T. Katoh, Y. Hirayama, N. Matsumoto, M. Takano, T. Ikeda, S. Yusu, S. Niwano, Y. Nakazato, Y. Kawano, M. Sumiyoshi, N. Hagiwara, K. Murasaki, H. Mitamura, S. Nakagawa, K. Okishige, K. Azegami, H. Aoyagi, K. Sugiyama, M. Nishizaki, N. Yamawake, I. Watanabe, K. Ohkubo, H. Sakurada, S. Fukamizu, M. Suzuki, W. Nagahori, T. Nakamura, Y. Murakawa, N. Hayami, K. Yoshioka, M. Amino, K. Hirao, A. Yagishita, K. Ajiki, K. Fujiu, Y. Imai, A. Yamashina, T. Ishiyama, M. Sakabe, K. Nishida, H. Asanoi, H. Ueno, J. D. Lee, Y. Mitsuke, H. Furushima, K. Ebe, M. Tagawa, M. Sato, M. Morikawa, K. Yamashiro, K. Takami, T. Ozawa, M. Watarai, M. Yamauchi, H. Kamiya, H. Hirayama, Y. Yoshida, T. Murohara, Y. Inden, H. Osanai, N. Ohte, T. Goto, I. Morishima, T. Yamamoto, E. Fujii, M. Senga, H. Hayashi, T. Urushida, Y. Takada, N. Tsuboi, T. Noda, T. Hirose, T. Onodera, S. Kageyama, T. Osaka, T. Tomita, K. Shimada, M. Nomura, H. Izawa, A. Sugiura, T. Arakawa, K. Kimura, T. Mine, T. Makita, H. Mizuno, A. Kobori, T. Haruna, M. Takagi, N. Tanaka, H. Shimizu, T. Kurita, K. Motoki, N. Takeda, Y. Kijima, M. Ito, A. Nakata, Y. Ueda, A. Hirata, S. Kamakura, K. Satomi, Y. Yamada, Y. Yoshiga, H. Ogawa, M. Kimura, T. Hayano, T. Kinbara, H. Tatsuno, M. Harada, K. F. Kusano, M. Adachi, A. Yano, M. Sawaguchi, J. Yamasaki, T. Matsuura, Y. Tanaka, H. Moritani, T. Maki, S. Okada, M. Takechi, T. Hamada, A. Nishikado, Y. Takagi, I. Matsumoto, T. Soeki, Y. Doi, M. Okawa, H. Seo, S. Kitamura, K. Yamamoto, M. Akizawa, N. Kaname, S. Ando, S. Narita, T. Inou, Y. Fukuizumi, K. Saku, M. Ogawa, Y. Urabe, M. Ikeuchi, S. Harada, H. Yamabe, Y. Imamura, Y. Yamanouchi, K. Sadamatsu, K. Yoshida, T. Kubota, N. Takahashi, N. Makino, Y. Higuchi, T. Ooie, T. Iwao, K. Kitamura, T. Imamura, K. Maemura, N. Komiya, M. Hayano, H. Yoshida, and K. Kumagai more...
- Subjects
Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,hypertension ,medicine.drug_class ,Diastole ,Hemorrhage ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Risk Factors ,Internal medicine ,Odds Ratio ,Medicine ,Humans ,Arrhythmia and Electrophysiology ,atrial fibrillation ,030212 general & internal medicine ,Prospective Studies ,Registries ,Risk factor ,Antihypertensive drug ,anticoagulation ,Antihypertensive Agents ,Original Research ,Ischemic Stroke ,Intracranial Hemorrhage ,Aged ,Proportional Hazards Models ,business.industry ,Hazard ratio ,Warfarin ,blood pressure ,Atrial fibrillation ,Odds ratio ,Middle Aged ,thromboembolism ,medicine.disease ,Blood pressure ,High Blood Pressure ,lcsh:RC666-701 ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - 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, CI 1.75–4.74, P 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. more...
- Published
- 2016