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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Effect of hypertension duration and blood pressure level on ischaemic stroke risk in atrial fibrillation: nationwide
Tae-Hoon Kim1, Pil-Sung Yang2, Hee Tae Yu1
1Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea.
European Heart Journal
|January 5, 2019
Summary
Longer hypertension duration increases ischaemic stroke risk in atrial fibrillation (AF) patients. Strict blood pressure control can mitigate this risk, especially in those with well-managed systolic blood pressure (SBP).
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Atrial fibrillation (AF) patients face increased risk of ischaemic stroke.
- Limited data exists on how hypertension duration and blood pressure (BP) levels impact stroke risk in AF patients.
Purpose of the Study:
- To investigate the association between hypertension duration and BP levels with ischaemic stroke risk in non-valvular AF patients.
- To determine if strict BP control can modify the risk associated with long-term hypertension.
Main Methods:
- Analysis of 246,459 oral anticoagulant-naïve non-valvular AF patients from the Korea National Health Insurance Service database (2005-2015).
- Assessment of ischaemic stroke risk based on hypertension duration and systolic BP (SBP) levels.
- Stratification of risk by age and pre-AF average SBP.
Main Results:
- Each year of increased hypertension duration raised ischaemic stroke risk by 7-9% up to 7 years, plateauing at a hazard ratio of 1.6.
- Linear increase in risk with hypertension duration observed in patients <65 years; plateau in patients ≥65 years.
- Longer hypertension duration correlated with higher stroke risk across SBP subgroups, except in those with SBP <120 mmHg.
Conclusions:
- Increased hypertension duration is linked to a higher risk of ischaemic stroke in AF patients.
- Long-term, strict systolic blood pressure control (<120 mmHg) can attenuate the elevated stroke risk associated with hypertension duration.
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