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Ideal Blood Pressure in Patients With Atrial Fibrillation.

Authors
 Daehoon Kim  ;  Pil-Sung Yang  ;  Tae-Hoon Kim  ;  Eunsun Jang  ;  Hyejung Shin  ;  Ha Yan Kim  ;  Hee Tae Yu  ;  Jae-Sun Uhm  ;  Jong-Youn Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung  ;  Gregory Y.H. Lip 
Citation
 Journal of the American College of Cardiology, Vol.72(11) : 1233-1245, 2018 
Journal Title
 Journal of the American College of Cardiology 
ISSN
 0735-1097 
Issue Date
2018
Keywords
atrial fibrillation ; cardiovascular outcome ; guideline ; hypertension
Abstract
BACKGROUND: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for High Blood Pressure in Adults redefined hypertension as systolic blood pressure (BP) ≥130 mm Hg or diastolic BP ≥80 mm Hg. The optimal BP for patients with atrial fibrillation (AF) is uncertain. OBJECTIVES: The goal of this study was to investigate the impacts of the 2017 ACC/AHA guideline and to determine the ideal BP threshold for the management of high BP in patients with AF. METHODS: This study analyzed data for 298,374 Korean adults with oral anticoagulant-naive, nonvalvular AF obtained from the National Health Insurance Service database from 2005 to 2015. RESULTS: According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure guideline, 62.2% of the individuals in our sample had hypertension. After applying the 2017 ACC/AHA guideline, 79.4% had hypertension, including 17.2% with newly redefined hypertension (130 to 139/80 to 89 mm Hg). Those with newly redefined hypertension had greater risks of major cardiovascular events (hazard ratio: 1.07; 95% confidence interval: 1.04 to 1.10; p < 0.001), ischemic stroke, intracranial hemorrhage, and heart failure admission, compared with nonhypertensive patients (<130/80 mm Hg). Among patients with AF undergoing hypertension treatment, patients with BP ≥130/80 mm Hg or <120/80 mm Hg were at significantly higher risks of major cardiovascular events than patients with BP of 120 to 129/<80 mm Hg. CONCLUSIONS: Patients with AF and newly redefined hypertension according to the 2017 ACC/AHA guideline were at higher risk of major cardiovascular events, suggesting that the new BP threshold is beneficial for timely diagnosis and intervention. BP of 120 to 129/<80 mm Hg was the optimal BP treatment target for patients with AF undergoing hypertension treatment.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/163508
DOI
10.1016/j.jacc.2018.05.076
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원)
Yonsei Authors
김종윤(Kim, Jong Youn)
김태훈(Kim, Tae-Hoon) ORCID logo https://orcid.org/0000-0003-4200-3456
김하얀(Kim, Ha Yan)
박희남(Pak, Hui Nam) ORCID logo https://orcid.org/0000-0002-3256-3620
엄재선(Uhm, Jae Sun) ORCID logo https://orcid.org/0000-0002-1611-8172
유희태(Yu, Hee Tae) ORCID logo https://orcid.org/0000-0002-6835-4759
이문형(Lee, Moon Hyoung) ORCID logo https://orcid.org/0000-0002-7268-0741
장은선(Jang, Eunsun) ORCID logo https://orcid.org/0000-0001-6991-4765
정보영(Joung, Bo Young) ORCID logo https://orcid.org/0000-0001-9036-7225
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