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Factors Associated with Nonachievement of Target Blood Pressure in Patients on Antithrombotic Therapy: A Real-World
Naoyuki Odaguchi1, Atsushi Sakima2, Tomohiro Yara3
1Blood Purification Center, Keiaikai Chibana Clinic, Okinawa, Japan.
Insights
Achieving target blood pressure (<130/80 mmHg) is difficult for patients on antithrombotic therapy. Obesity is a key factor for nonachievement, while heart failure may offer protection.
Area of Science:
- Cardiology
- Hypertension Management
- Pharmacology
Background:
- Current hypertension guidelines recommend strict blood pressure (BP) control (<130/80 mmHg) for patients on antithrombotic therapy to prevent bleeding.
- A small proportion of these patients achieve the target BP, necessitating further investigation into contributing factors.
Purpose of the Study:
- To identify factors associated with the nonachievement of the target BP value (≥130/80 mmHg) in patients receiving antithrombotic therapy.
Main Methods:
- Retrospective study of 2,201 outpatients on antithrombotic therapy in 2018.
- Office BP measured once in a sitting position, with target BP defined by Japanese Society of Hypertension Guidelines.
- Logistic regression analysis used to identify correlations with nonachievement of target BP.
Main Results:
- Only 30.6% of patients achieved the target BP of <130/80 mmHg.
- Male gender and obesity were significantly associated with nonachievement of target BP.
- Heart failure and ischemic heart disease showed a negative correlation with nonachievement, suggesting a protective effect.
Conclusions:
- The target BP is achieved in a minority of patients on antithrombotic therapy.
- Obesity is a modifiable risk factor for failing to reach target BP.
- Cardiovascular comorbidities like heart failure may be associated with better BP control in this population.
Introduction:
The current guidelines for managing hypertension recommend strict blood pressure (BP) control to prevent bleeding complications in patients with hypertension on antithrombotic therapy. However, the target BP value of <130/80 mmHg is achieved in a small proportion of these patients. This study aimed to examine the factors associated with nonachievement of target BP value (≥130/80 mmHg) in patients on antithrombotic therapy.
Methods:
This retrospective study was conducted at an outpatient clinic in 2018. Clinical parameters were obtained from the center's electronic medical database. Office BP was measured once in the sitting position. A target BP value of <130/80 mmHg was defined according to the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2019.
Results:
Of the 26,803 outpatients who had scheduled visits during this time, 2,427 received antithrombotic therapy. Patients with chronic kidney disease stage 5 or on hemodialysis and those with missing data on body mass index were excluded from the study; eventually, 2,201 outpatients met the inclusion criteria. BP values of <140/90 mmHg were observed in 59.2% of these outpatients; however, only 30.6% displayed the target BP value of <130/80 mmHg. Univariate and multivariate logistic regression analyses indicated that male gender and obesity significantly correlated with nonachievement of the target BP (≥130/80 mmHg). However, heart failure and ischemic heart disease were negatively but significantly related to nonachievement of the target BP.
Conclusions:
The target BP value was achieved in only a small proportion of the patients treated with antithrombotic drugs. In patients on antithrombotic therapy, obesity appeared to be a modifiable risk factor, whereas cardiovascular comorbidities, such as heart failure, were negative factors contributing to nonachievement of the target BP.
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