Impact of pre-existing hypertension and control status before atrial fibrillation onset on cardiovascular prognosis in patients with non-valvular atrial fibrillation: A real-world database analysis in Japan

Abstract

Hypertension is an important risk factor for non-valvular atrial fibrillation (NVAF) and its prognosis. However, there is no study to clarify the impact of pre-existing hypertension and BP control status before the onset of AF on the prognosis after the onset of AF. This retrospective real-world cohort analysis used data from the Japan Medical Data Center Co., Ltd database. The presence of NVAF and hypertension, plus the occurrence of adverse events, was based on ICD-10 codes in the database. The primary composite AF-related cardiovascular event end point included ischemic stroke, hemorrhagic stroke, and acute myocardial infarction. Of the 21 523 patients identified as having new-onset NVAF between January 2005 and June 2016, 7885 had blood pressure (BP) data before the onset of NVAF available and were included in the analysis (4001 with pre-existing hypertension and 3884 without pre-existing hypertension). The rate of primary composite end point events was 10.3 and 4.4 per 1000 patient-years in patients with and without hypertension, respectively (P < .001). In addition, lower systolic BP (<120 mm Hg) before the onset of NVAF was associated with a lower incidence of cardiovascular events after the development of NVAF (P < .001). This highlights the importance of earlier and tighter 24-hour BP control before the onset of NVAF in patients with hypertension, not only for reducing the occurrence of new-onset of NVAF, but also for reducing both hemorrhagic and ischemic cardiovascular events after the onset of NVAF.

Keywords: atrial fibrillation; cardiovascular events; morbidity; mortality; pre-existing hypertension; stroke.

Figure 1

Kaplan‐Meier curves showing the rate of cardiovascular events (ischemic stroke, hemorrhagic stroke, and acute myocardial infarction) in non‐valvular atrial fibrillation (NVAF) patients with vs without pre‐existing hypertension before the onset of NVAF, overall (A), in patients aged <60 and ≥60 y with and without pre‐existing hypertension (B), and in subgroups based on systolic blood pressure before NVAF onset (C). HT, hypertension; NT, normotension