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New BP threshold identifies risk in patients with AF, hypertension
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Patients with atrial fibrillation who also have hypertension as defined by the 2017 guideline had increased risk for major CV events, leading researchers for a new study to state that “the new BP threshold is beneficial for timely diagnosis and intervention.”
In this study, a BP of 120 to 129/less than 80 mm Hg was the optimal BP target for this population of patients with AF undergoing hypertension treatment.
As Cardiology Today previously reported, the 2017 guideline by the American College of Cardiology, the American Heart Association and nine other societies redefined hypertension as systolic BP 130 mm Hg or greater.
New threshold beneficial
“Patients with AF and newly redefined hypertension according to the 2017 ACC/AHA guideline were at higher risks of major cardiovascular events, ischemic stroke, intracranial hemorrhage and heart failure admission compared with nonhypertensive patients, suggesting that the new BP threshold may be beneficial for patients with AF,” Daehoon Kim, MD, from the division of cardiology at Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea, and colleagues wrote. “In these patients with AF undergoing hypertension treatment, a U-shaped relationship of major cardiovascular events was evident, with [systolic] BP 120 to 129 and [diastolic] BP < 80 mm Hg as the optimal BP treatment target.”
Using the Korean national health claims database, researchers identified 298,374 patients who were aged at least 20 years and had incident AF diagnoses between 2005 and 2015.
Patients were categorized by their hypertension treatment history or, if none, by their measured BP. The categories for measured BP were nonhypertensive (BP < 130/< 80 mm Hg), newly redefined hypertension (systolic BP 130 to 139 mm Hg or diastolic BP 80 to 89 mm Hg, in accordance with the 2017 ACC/AHA guideline compared with the seventh Joint National Committee report (JNC 7)), hypertension according to the 2017 ACC/AHA guideline (systolic BP 130 mm Hg or diastolic BP 80 mm Hg) or hypertension according to JNC 7 (systolic BP 140 mm Hg or diastolic BP 90 mm Hg).
The proportion of patients with AF who would meet the definition of hypertension under JNC 7 and the 2017 ACC/AHA guideline was estimated. For patients with no history of treated hypertension, researchers used two Cox models to assess the risk for adverse outcomes for adults considered to have hypertension under each guideline and those with newly redefined hypertension.
Of patients with AF and no hypertension treatment history, 20.6% had BP levels of less than 130/80 mm Hg, 17.2% had BP levels of 130 to 139/80 to 89 mm Hg and 9.2% had BP levels of at least 140/90 mm Hg.
History of CVD was also considered and defined as a previous diagnosis of MI, CHD, stroke or HF. Researchers predicted 10-year CVD risk by using pooled cohort risk equations.
The primary clinical outcome was the first occurrence of major CV events, ischemic stroke, intracranial hemorrhage, MI and HF requiring hospitalization.
Patients were followed from the index date until one of the study outcomes occurred, the date that oral anticoagulants were initiated or at the end of follow-up, whichever came first. Follow-up was for a mean of 5.6 years.
Researchers found that, when using JNC 7, 62.2% of the cohort had hypertension, but after applying the 2017 ACC/AHA guideline, 79.4% had hypertension, which included 17.2% with newly redefined hypertension.
CV event risk
Participants with hypertension according to the new guideline had greater risks for major CV events (HR = 1.07; 95% CI, 1.04-1.1), ischemic stroke (HR = 1.11; 95% CI, 1.07-1.16), intracranial hemorrhage (HR = 1.11; 95% CI, 1.01-1.22) and HF admission (HR = 1.06; 95% CI, 1.01-1.11) than those without hypertension.
Furthermore, for patients with AF undergoing hypertension treatment, those with BP of at least 130 mm Hg systolic/80 mm Hg diastolic or less than 120 mm Hg systolic /80 mm Hg diastolic were at higher risk for major CV events than those with systolic BP 120 to 129 mm Hg/diastolic BP less than 80 mm Hg.
There were no significant differences in all-cause mortality or MI between patients with hypertension and those without, according to researchers.
“This study is the first comprehensive investigation to evaluate optimal BP thresholds in patients with AF using the entire population of one country,” the researchers wrote. “It presents the largest population dataset available in the literature to investigate the relationships between BP levels and cardiovascular outcomes in oral anticoagulant-naive patients with AF.” – by Melissa J. Webb
Disclosures: One author reports he serves as a consultant and/or speaker for Bayer/Janssen, Biotronik, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daiichi Sankyo, Medtronic, Novartis and Verseon.
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