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Blood Pressure Control and Cardiovascular Outcomes in Patients With Atrial Fibrillation (From the ORBIT-AF Registry)

Sreekanth Vemulapalli1, Taku Inohara1, Sunghee Kim1

  • 1Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.

The American Journal of Cardiology
|March 9, 2019
PubMed

Insights

In atrial fibrillation (AF) patients, uncontrolled systolic blood pressure (SBP) is common and linked to higher risks of stroke, heart attack, and bleeding. More rigorous blood pressure management is crucial for better outcomes.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Atrial Fibrillation Research

Background:

  • Systolic blood pressure (SBP) control and its impact on clinical outcomes in community-based atrial fibrillation (AF) patients remain understudied.
  • Hypertension is a prevalent comorbidity in AF patients, significantly influencing their prognosis.

Purpose of the Study:

  • To assess the prevalence of uncontrolled hypertension and SBP control changes in AF patients.
  • To identify predictors of uncontrolled SBP over a two-year follow-up period.
  • To determine the association between SBP levels and adverse clinical outcomes, including cardiovascular events and major bleeding.

Main Methods:

  • Analysis of 10,132 AF patients from the ORBIT-AF registry (2010-2014).
  • Patients were categorized based on hypertension history and baseline SBP (<140 mm Hg for controlled, >140 mm Hg for uncontrolled).
  • Pooled logistic regression identified SBP predictors; random effects Cox regression analyzed the relationship between SBP and clinical outcomes.

Main Results:

  • 83% of AF patients had hypertension, with 24.2% having uncontrolled baseline SBP, showing minimal improvement over two years.
  • Predictors of elevated follow-up SBP included uncontrolled baseline SBP, female sex, prior percutaneous coronary intervention, and diabetes.
  • Each 5 mm Hg increase in SBP was associated with a modest increase in the adjusted risk of stroke/TIA, myocardial infarction, and major bleeding.

Conclusions:

  • Elevated SBP in AF patients is significantly associated with increased risks of adverse cardiovascular events and major bleeding.
  • Current SBP control in this population is suboptimal, with little change observed over two years.
  • Emphasizing more rigorous blood pressure management is essential for improving clinical outcomes in patients with atrial fibrillation.

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