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
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.