Department of Cardiology, Dongkang Hospital, Ulsan, Korea.
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Am J Cardiol. 2022 Oct 1;180:37-43. doi: 10.1016/j.amjcard.2022.06.036. Epub 2022 Aug 5.
Hypertension is an independent risk factor for thromboembolic events in patients with atrial fibrillation (AF). However, the association between blood pressure (BP) control and thromboembolic events remains under-evaluated in patients with AF. We aimed to identify the relation between BP control and the risk of ischemic stroke and systemic embolism in hypertensive patients with AF. Data on 13,712 consecutive patients with AF (9,505 with and 4,207 without hypertension) were retrospectively analyzed. The hypertensive group was divided into quartiles according to the initial BP, linearly interpolated mean BP, variability independent of the mean of the BP, and time in therapeutic range (<130 mm Hg for systolic BP [SBP] and <80 mm Hg for diastolic BP) during follow-up. The primary outcome was ischemic stroke and systemic embolism. The mean follow-up duration of the study population was median 2.7 years (interquartile range 1.1 to 4.9 years), and the median number of BP measurements was 14 (interquartile range 6 to 25) times. Strictly controlled initial and interpolated mean BP and low variability in controlled BP (variability independent of the mean) were associated with a lower risk of ischemic stroke and systemic embolism for both SBP and diastolic BP. A similar risk was observed in patients with strictly controlled SBP (time in therapeutic range under 130 mm Hg >94%) and those without hypertension. In conclusion, continuous and strict maintenance of SBP under 130 mm Hg with low variability at outpatient clinic follow-up reduces the risk of ischemic stroke and systemic embolism in patients with hypertension and AF.
高血压是心房颤动（AF）患者血栓栓塞事件的独立危险因素。然而，AF 患者血压（BP）控制与血栓栓塞事件之间的关系仍未得到充分评估。我们旨在确定高血压合并 AF 患者的 BP 控制与缺血性卒中和系统性栓塞风险之间的关系。回顾性分析了 13712 例连续 AF 患者（9505 例伴高血压，4207 例无高血压）的数据。根据初始 BP、线性内插平均 BP、BP 均值独立变异和治疗范围内时间（收缩压[SBP]<130mmHg，舒张压<80mmHg）将高血压组分为四分位数。主要结局是缺血性卒中和系统性栓塞。研究人群的平均随访时间中位数为 2.7 年（四分位距 1.1 至 4.9 年），BP 测量中位数为 14 次（四分位距 6 至 25 次）。严格控制的初始和内插平均 BP 以及控制 BP 的低变异性（BP 均值独立变异）与 SBP 和舒张压的缺血性卒中和系统性栓塞风险降低相关。在严格控制 SBP（治疗范围内时间>94%，SBP 时间低于 130mmHg）和无高血压的患者中也观察到了类似的风险。总之，门诊随访时持续且严格地将 SBP 控制在 130mmHg 以下，并保持低变异性可降低高血压合并 AF 患者发生缺血性卒中和系统性栓塞的风险。
