Department of Cardiovascular Sciences, Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group.
National Institute for Health Research Leicester Biomedical Research Centre.
J Hypertens. 2020 Sep;38(9):1820-1828. doi: 10.1097/HJH.0000000000002487.
Limited data exist to inform blood pressure (BP) thresholds for patients with atrial fibrillation prescribed direct oral anticoagulants (DOAC) therapy in the real world setting.
SBP was measured in 9051 primary care patients in England on DOACs for atrial fibrillation with postinitiation BP levels available within the Clinical Practice Research Datalink. The incidence rate for the primary outcome of the first recorded event (defined as a diagnosis of first stroke, recurrent stroke, myocardial infarction, symptomatic intracranial bleed, or significant gastrointestinal bleed) and of secondary outcomes all-cause mortality and cardiovascular mortality were calculated by postinitiation BP groups.
The Cox proportional hazard ratio of an event [crude and adjusted hazard ratio 1.04 (95% confidence interval (CI) 1.00-1.08), P = 0.077 and 0.071, respectively] did not differ significantly with a 10 mmHg increase in SBP. The hazard of all-cause mortality [crude hazard ratio 0.83 (95% CI 0.80-0.86), P = 0.000; adjusted hazard ratio 0.84 (95% CI 0.81-0.87), P = 0.000] and cardiovascular mortality [crude hazard ratio 0.92 (95% CI 0.85-0.99), P = 0.021; adjusted hazard ratio 0.93 (95% CI 0.86-1.00), P = 0.041] demonstrated a significant inverse relationship with a 10 mmHg increase in SBP. Patients with a SBP within 161-210 mmHg had the lowest all-cause death rate, while patients with SBP within 121-140 mmHg had the lowest cardiovascular death rate.
SBP values below 161 mmHg are associated higher all-cause mortality, but lower event risk in patients with atrial fibrillation on DOAC therapy. The nadir SBP for lowest event rate was 120 mmHg, for lowest cardiovascular mortality was 130 mmHg and for lowest all-cause mortality was 160 mmHg. This demonstrates a need for a prospective interventional study of BP control after initiation of anticoagulation.
在真实世界环境中，接受直接口服抗凝剂 (DOAC) 治疗的心房颤动患者，目前仅有少量数据可用于指导血压 (BP) 阈值。
在英格兰，9051 名接受 DOAC 治疗的心房颤动患者的初级保健中测量收缩压 (SBP)，并在临床实践研究数据库中获得了起始后 BP 水平。通过起始后 BP 组计算主要结局（首次记录事件，定义为首次中风、复发性中风、心肌梗死、症状性颅内出血或重大胃肠道出血）和次要结局（全因死亡率和心血管死亡率）的发生率。
事件的 Cox 比例风险比（未经调整和调整后的风险比分别为 1.04 [95%置信区间 (CI) 1.00-1.08]，P=0.077 和 0.071）与 SBP 升高 10mmHg 无显著差异。全因死亡率的风险[未经调整的风险比 0.83 (95% CI 0.80-0.86)，P=0.000；调整后的风险比 0.84 (95% CI 0.81-0.87)，P=0.000]和心血管死亡率[未经调整的风险比 0.92 (95% CI 0.85-0.99)，P=0.021；调整后的风险比 0.93 (95% CI 0.86-1.00)，P=0.041]与 SBP 升高 10mmHg 呈显著负相关。SBP 范围在 161-210mmHg 的患者全因死亡率最低，SBP 范围在 121-140mmHg 的患者心血管死亡率最低。
接受 DOAC 治疗的心房颤动患者，SBP 值低于 161mmHg 与全因死亡率升高相关，但事件风险较低。SBP 值最低的事件发生率为 120mmHg，最低的心血管死亡率为 130mmHg，最低的全因死亡率为 160mmHg。这表明需要对抗凝治疗开始后血压控制进行前瞻性干预研究。
