Systolic blood pressure (SBP) and its association with clinical outcomes in atrial
fibrillation (AF) patients in community practice are poorly characterized. In patients
with AF, we sought to (1) examine the prevalence of baseline uncontrolled hypertension
and the overall change in SBP control, (2) identify predictors of uncontrolled SBP
over 2 years of follow-up, and (3) determine the relation between SBP and clinical
outcomes. We analyzed 10,132 patients with AF at 176 clinics in the ORBIT-AF registry
between 2010 and 2014, classified as: (1) no history of hypertension; (2) controlled
hypertension (baseline SBP <140 mm Hg); (3) and uncontrolled hypertension (baseline
SBP >140 mm Hg). Predictors of SBP >140 mm Hg at baseline or in follow-up were identified
with pooled logistic regression. Random effects Cox regression models were used to
compare cardiovascular outcomes and major bleeding as a function of continuous, time-dependent
SBP. Overall 8,383 (83%) of patients with AF had hypertension. Of these, 24.2% (n = 2032)
had uncontrolled baseline SBP, with little change over 2 years. Predictors of elevated
follow-up SBP included uncontrolled baseline SBP, females, previous percutaneous coronary
intervention, and diabetes. For every 5 mm Hg increase in follow-up SBP, the adjusted
risk of stroke or systemic embolism or transient ischemic attack (adjusted hazard
ratio [aHR] 1.05, 95% confidence interval [CI] 1.01 to 1.08, p = 0.01), myocardial
infarction (aHR 1.05, 95% CI 1.00 to 1.11, p = 0.04), and major bleeding (aHR 1.03,
95% CI 1.00 to 1.06, p = 0.04) increased modestly. In conclusion, in patients with
AF, higher SBP was associated with increasing adverse events; therefore, more rigorous
blood pressure control should be emphasized.
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Article Info
Publication History
Published online: February 23, 2019
Received in revised form:
February 7,
2019
Received:
November 16,
2018
Footnotes
Funding: The ORBIT-AF registry is sponsored by Janssen Scientific Affairs , LLC, Titusville, NJ. The authors are solely responsible for the design and conduct of the study; collection, management, analysis, and interpretation of the data. The authors are also solely responsible for the preparation, review, and approval of the manuscript. The authors are solely responsible for the decision to submit the manuscript for publication.
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