Key result
Home SBP ≥145 mm Hg linked to ~92% higher risk of net cardiovascular outcomes in elderly AF.
Why the study?
Does high home systolic blood pressure predict the risk of stroke, systemic embolic events, and major bleeding in elderly patients with nonvalvular atrial fibrillation?
Cohort (n=4,933)
Yes
Does high home systolic blood pressure predict the risk of stroke, systemic embolic events, and major bleeding in elderly patients with nonvalvular atrial fibrillation?
Hazard Ratio: 1.92 (95% CI 1.21–3.06)
Absolute Event Rate: 3.24% vs 1.67%
p-value: p=0.006
In elderly patients with nonvalvular atrial fibrillation, home systolic blood pressure ≥145 mm Hg is a significant predictor of stroke, major bleeding, and intracranial hemorrhage, suggesting the utility of home BP monitoring for risk assessment.
Home SBP ≥145 mm Hg may aid prognostication in elderly nonvalvular AF; leaves open whether targeting it reduces net events.
BACKGROUND: Blood pressure (BP) fluctuates significantly in patients with atrial fibrillation (AF); office BP measurements seem insufficient to assess AF patient risk accurately. We hypothesized that home BP could better predict the risk of stroke/systemic embolic events (SEE) and major bleeding in patients with AF than office BP. METHODS: In this prespecified subcohort study of the ANAFIE (All Nippon AF in the Elderly) Registry, we evaluated the impact of home BP on the risk of stroke/SEE, major bleeding, intracranial hemorrhage, all-cause death, and net cardiovascular outcome (a composite of stroke/SEE and major bleeding). At enrollment, home BP was measured twice in the morning and evening for 7 days. RESULTS: In total, 4933 elderly patients (aged ≥75 years) with nonvalvular AF participated. Incidences of net cardiovascular outcome, stroke/SEE, major bleeding, and intracranial hemorrhage increased significantly with increasing home systolic BP (H-SBP). Compared with H-SBP <125 mm Hg, ≥145 mm Hg was associated with increased risk of these events. The association between H-SBP and the events was observed only in patients with ≥20 H-SBP measurements. CONCLUSIONS: In elderly patients with nonvalvular AF, high H-SBP (≥145 mm Hg) was a significant predictor of stroke/SEE, major bleeding, and intracranial hemorrhage risk. Strict BP control guided by the increasing number of home BP measurements may provide an accurate clinical outcome risk assessment. REGISTRATION: URL: https://www.umin.ac.jp/ctr; Unique identifier: UMIN000024006.
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Kario et al. (2022) conducted a cohort in Nonvalvular Atrial Fibrillation (n=4,933). Home systolic blood pressure ≥145 mm Hg vs. Home systolic blood pressure <125 mm Hg was evaluated on Net cardiovascular outcome (composite of stroke/systemic embolic events and major bleeding) incidence per 100 person-years (HR 1.92, 95% CI 1.21-3.06, p=0.006). Compared to <125 mm Hg, home systolic blood pressure ≥145 mm Hg increased the risk of net cardiovascular outcomes (HR 1.92) in elderly patients with nonvalvular atrial fibrillation.
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