Impact of Blood Pressure Control on Thromboembolism and Major Hemorrhage in Patients With Nonvalvular Atrial Fibrillation: A Subanalysis of the J-RHYTHM Registry

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 cha2ds2-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. © 2016 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.