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ARISTOTLE: Poorly controlled BP greatly increased risk for stroke in patients with AF

Issue: May 2014

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WASHINGTON — Poorly controlled BP was independently associated with a 50% higher risk for stroke in the ARISTOTLE clinical trial population of patients with atrial fibrillation, according to data presented at the American College of Cardiology Scientific Sessions.

Researchers also found that the benefit of the oral anticoagulant apixaban (Eliquis, Bristol-Myers Squibb/Pfizer) over warfarin for the prevention of stroke or systemic embolism was consistent regardless of BP control.

“These data highlight the critical importance of [BP] control in addition to anticoagulation in helping to lower the risk of stroke in patients with [AF],” Meena Rao, MD, MPH, from Duke Clinical Research Institute at Duke University Medical Center, said in a company press release.

Of the 18,201 patients enrolled in ARISTOTLE, 87.5% had a history of hypertension, according to Rao and colleagues. Patients with a history of hypertension had higher CHA₂DS₂-VASc scores but similar HAS-BLED scores as patients with no history of hypertension.

After adjustment, the 50% of patients who had poorly controlled hypertension during the trial had an elevated risk for stroke or systemic embolism compared with those whose BP was under control (HR=1.53; 95% CI, 1.25-1.86). Patients with uncontrolled BP during the trial were at greater risk for major bleeding (HR=1.14; 95% CI, 1.01-1.28) and any bleeding (HR=1.11; 95% CI, 1.04-1.18), according to the researchers.

Rao and colleagues also found that patients randomly assigned to apixaban had lower rates of stroke or systemic embolism compared with those assigned warfarin, regardless of hypertension history (P for interaction=.27), BP control at baseline (P for interaction=.43) or BP control during the trial (P for interaction=.93). – by Erik Swain

For more information:

Rao M. Abstract #1143-147. Presented at: American College of Cardiology Scientific Sessions; March 29-31, 2014; Washington, D.C.

Disclosure: The ARISTOTLE trial was funded by Bristol-Myers Squibb and Pfizer. Rao reports receiving a research grant from Medtronic.