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. 2018 Sep 11;72(11):1233-1245.
doi: 10.1016/j.jacc.2018.05.076.

Ideal Blood Pressure in Patients With Atrial Fibrillation

Daehoon Kim  1 , Pil-Sung Yang  2 , Tae-Hoon Kim  1 , Eunsun Jang  1 , Hyejung Shin  3 , Ha Yan Kim  3 , Hee Tae Yu  1 , Jae-Sun Uhm  1 , Jong-Youn Kim  1 , Hui-Nam Pak  1 , Moon-Hyoung Lee  1 , Boyoung Joung  4 , Gregory Y H Lip  5
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Free article

Ideal Blood Pressure in Patients With Atrial Fibrillation

Daehoon Kim et al. J Am Coll Cardiol. .
Free article

Abstract

Background: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for High Blood Pressure in Adults redefined hypertension as systolic blood pressure (BP) ≥130 mm Hg or diastolic BP ≥80 mm Hg. The optimal BP for patients with atrial fibrillation (AF) is uncertain.

Objectives: The goal of this study was to investigate the impacts of the 2017 ACC/AHA guideline and to determine the ideal BP threshold for the management of high BP in patients with AF.

Methods: This study analyzed data for 298,374 Korean adults with oral anticoagulant-naive, nonvalvular AF obtained from the National Health Insurance Service database from 2005 to 2015.

Results: According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure guideline, 62.2% of the individuals in our sample had hypertension. After applying the 2017 ACC/AHA guideline, 79.4% had hypertension, including 17.2% with newly redefined hypertension (130 to 139/80 to 89 mm Hg). Those with newly redefined hypertension had greater risks of major cardiovascular events (hazard ratio: 1.07; 95% confidence interval: 1.04 to 1.10; p < 0.001), ischemic stroke, intracranial hemorrhage, and heart failure admission, compared with nonhypertensive patients (<130/80 mm Hg). Among patients with AF undergoing hypertension treatment, patients with BP ≥130/80 mm Hg or <120/80 mm Hg were at significantly higher risks of major cardiovascular events than patients with BP of 120 to 129/<80 mm Hg.

Conclusions: Patients with AF and newly redefined hypertension according to the 2017 ACC/AHA guideline were at higher risk of major cardiovascular events, suggesting that the new BP threshold is beneficial for timely diagnosis and intervention. BP of 120 to 129/<80 mm Hg was the optimal BP treatment target for patients with AF undergoing hypertension treatment.

Keywords: atrial fibrillation; cardiovascular outcome; guideline; hypertension.

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