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Effect of hypertension duration and blood pressure level on ischaemic stroke risk in atrial fibrillation: nationwide data covering the entire Korean population

 Tae-Hoon Kim  ;  Pil-Sung Yang  ;  Hee Tae Yu  ;  Eunsun Jang  ;  Hyejung Shin  ;  Ha Yan Kim  ;  Jae-Sun Uhm  ;  Jong-Youn Kim  ;  Jung-Hoon Sung  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung  ;  Gregory Y H Lip 
 European Heart Journal, Vol.40(10) : 809-819, 2019 
Journal Title
 European Heart Journal 
Issue Date
Atrial fibrillation ; Blood pressure ; Duration ; Hypertension ; Ischaemic stroke
AIMS: There are a paucity of data on the association of duration of hypertension and blood pressure (BP) level with risk of ischaemic stroke in patients with atrial fibrillation (AF). Our objective was to investigate the association between duration of hypertension and secondly, BP levels with risk of ischaemic stroke among patients with AF. METHODS AND RESULTS: A total of 246 459 oral anticoagulant-naïve non-valvular AF patients were enrolled from Korea National Health Insurance Service (NHIS) database (2005-2015). The risk of ischaemic stroke according to the duration of hypertension and systolic BP (SBP) levels were assessed. One-year increase of hypertension duration continuously increased the adjusted risk of ischaemic stroke (95% confidence interval 1.07-1.09) until 7 years, and reached a plateau with adjusted hazard ratio of 1.6. Risk of ischaemic stroke increased linearly with the increase of hypertension duration in patients younger than 65 years of age, whereas the risk reached a plateau in patients aged 65 years or older. In all baseline and pre-AF average SBP subgroups, longer duration of hypertension before AF was associated with higher ischaemic stroke risk than shorter duration of hypertension (all P-values for trends <0.01). However, the effect of long-term hypertension was not observed in patients with strictly well-controlled pre-AF average SBP of less than 120 mmHg. CONCLUSION: The increase of hypertension duration was associated with the increased risk of ischaemic stroke. However, this long-term effect of hypertension duration can be attenuated by long-term strict SBP control throughout the entire duration of hypertension.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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