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

2016; Wiley; Volume: 5; Issue: 9 Linguagem: Inglês

10.1161/jaha.116.004075

2047-9980

Eitaro Kodani, Hirotsugu Atarashi, Hiroshi Inoue, Ken Okumura, Takeshi Yamashita, Toshiaki Otsuka, Hirofumi Tomita, Hideki Origasa, M Sakurai, Yoshiaki Kawamura, I. Kubota, Yoshiaki Kaneko, Kazuo Matsumoto, Satoshi Ogawa, Yoshiyasu Aizawa, I. Kodama, Eiichi Watanabe, Yukihiro Koretsune, Yuka Okuyama, Akihiko Shimizu, Osamu Igawa, Shigenobu Bando, M. Fukatani, Tetsunori Saikawa, Akiko Chishaki, N Kato, Katsuya Kanda, J. Kato, Hiroaki Obata, Masashi Aoki, Hiroto Honda, Y. Konta, Toru Hatayama, Yukihiko Abe, Ken Terata, Takahide Yagi, Akihiko Ishida, T Komatsu, Hideaki Tachibana, Hidenori Suzuki, Yoshiyuki Kamiyama, Tomonori Watanabe, Masaki Oguma, M. Itoh, Osamu Hirono, Yuichi Tsunoda, Kenichi Ikeda, Tohru Kanaya, Kenzo Sakurai, Hiroyasu Sukekawa, Seigo Nakada, Taihei Itoh, Shoichi Tange, Mamoru Manita, Mutsuko Ohta, Hiromi Eguma, Ritsushi Kato, Yoshiko Endo, Tadayoshi Ogino, Masahiro Yamazaki, Hideaki Kanki, M Uchida, Satoru Miyanaga, Kentaro Shibayama, Notitaka Toratani, Toshiaki Kojima, Mari Ichikawa, Makoto Saito, Yuji Umeda, Takao Sawanobori, Hiroshi Sohara, S. Okubo, Tomoyuki Ōkubo, T Tokunaga, Osamu Kuboyama, Hiroshi Ito, Younosuke Kitahara, Koichi Sagara, Toshihiko Satoh, Kaoru Sugi, Yuya Kobayashi, Yukihito Higashi, Tomoe Katoh, Yudai Hirayama, Naoya Matsumoto, Makoto Takano, Takanori Ikeda, Satoru Yusu, Shinichi Niwano, Yuji Nakazato, Yuhei Kawano, Masataka Sumiyoshi, N Hagiwara, Kagari Murasaki, Hideo Mitamura, Shunki Nakagawa, Kaoru Okishige, Kouji Azegami, Hideki Aoyagi, Kazutoshi Sugiyama, Mitsuhiro Nishizaki, Noriyoshi Yamawake, Isao Watanabe, Kimie Ohkubo, Harumizu Sakurada, Seiji Fukamizu, Makoto Suzuki, Wataru Nagahori, Tsukasa Nakamura, Yuji Murakawa, Noriyuki Hayami, Kazuhiro Yoshioka, Mari Amino, Keizo Hirao, Atsuhiko Yagishita, Kohsuke Ajiki, Katsuhito Fujiu, Yutaka Imai, Akira Yamashina, Taizou Ishiyama, Masao Sakabe, Kunihiro Nishida, Hidetsugu Asanoi, Hiroshi Ueno, J. D. Lee, Yasuhiko Mitsuke, Hiroshi Furushima, Katsuya Ebe, Minoru Tagawa, Miho Sato, Masato Morikawa, Kazuo Yamashiro, Kaoru Takami, Tadashi Ozawa, Masato Watarai, Moriyasu Yamauchi, H. Kamiya, Hiroyoshi Hirayama, Yoshitaro Yoshida, Toyoaki Murohara, Yasuya Inden, Hiroyuki Osanai, Nobuyuki Ohte, Teruaki Goto, Itsuro Morishima, Takashi Yamamoto, Eitaro Fujii, Michiharu Senga, Hidemori Hayashi, Tsuyoshi Urushida, Yoshiaki Takada, Nobuo Tsuboi, Takashi Noda, Takuo Hirose, Tomoya Onodera, Shinji Kageyama, Takafumi Osaka, Takeshi Tomita, Kazuyuki Shimada, Miki Nomura, Hideo Izawa, Atsushi Sugiura, Tomoharu Arakawa, Kenjiro Kimura, Takanao Mine, Toshinori Makita, Hiroyuki Mizuno, Atsushi Kobori, Tetsuya Haruna, Masahito Takagi, Noriko Tanaka, Hiroaki Shimizu, Takashi Kurita, Koichiro Motoki, Norifumi Takeda, Yasufumi Kijima, Masahiro Ito, Atsuyuki Nakata, Y. Ueda, A Hirata, Shiro Kamakura, Kazuhiro Satomi, Yoko Yamada, Yasuhiro Yoshiga, Hisashi Ogawa, M. Kimura, Takashi Hayano, Takeshi Kinbara, H Tatsuno, Masako Harada, Kuninori Kusano, Masaki Adachi, Akemi Yano, Makoto Sawaguchi, Junichi Yamasaki, Tomomi Matsuura, Yoshihiro Tanaka, Hisato Moritani, Takeshi Maki, Sadanori Okada, Mineki Takechi, Takashi Hamada, Akiyoshi Nishikado, Yuichiro Takagi, Ichiro Matsumoto, Takeshi Soeki, Yoshinori Doi, Makoto Okawa, Hye Mi Seo, S Kitamura, Koujirou YAMAMOTO, M Akizawa, Noriyoshi Kaname, Shin‐ichi Ando, Sumito Narita, T Inou, Yutaka Fukuizumi, K. Saku, Masaya Ogawa, Yoji Urabe, Mayumi Ikeuchi, Shoko Harada, Hiroshige Yamabe, Yusuke Imamura, Yoshinori Yamanouchi, Kenji Sadamatsu, Kōji Yoshida, Tomoki Kubota, Naohiko Takahashi, Nobuhiko Makino, You Higuchi, Tatsuhiko Ooie, Tetsu Iwao, K Kitamura, Teruhiko Imamura, Koji Maemura, N. Komiya, Motonobu Hayano, Hisako Yoshida, Koji Kumagai,

Cardiac Arrhythmias and Treatments

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.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.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.URL: http://www.umin.ac.jp/ctr. Unique identifier: UMIN000001569.