Factors Associated with Nonachievement of Target Blood Pressure in Patients on Antithrombotic Therapy: A Real-World Study

Abstract

Introduction: The current guidelines for managing hypertension recommend strict blood pressure (BP) control to prevent bleeding complications in patients with hypertension on antithrombotic therapy. However, the target BP value of <130/80 mmHg is achieved in a small proportion of these patients. This study aimed to examine the factors associated with nonachievement of target BP value (≥130/80 mmHg) in patients on antithrombotic therapy.

Methods: This retrospective study was conducted at an outpatient clinic in 2018. Clinical parameters were obtained from the center's electronic medical database. Office BP was measured once in the sitting position. A target BP value of <130/80 mmHg was defined according to the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2019.

Results: Of the 26,803 outpatients who had scheduled visits during this time, 2,427 received antithrombotic therapy. Patients with chronic kidney disease stage 5 or on hemodialysis and those with missing data on body mass index were excluded from the study; eventually, 2,201 outpatients met the inclusion criteria. BP values of <140/90 mmHg were observed in 59.2% of these outpatients; however, only 30.6% displayed the target BP value of <130/80 mmHg. Univariate and multivariate logistic regression analyses indicated that male gender and obesity significantly correlated with nonachievement of the target BP (≥130/80 mmHg). However, heart failure and ischemic heart disease were negatively but significantly related to nonachievement of the target BP.

Conclusions: The target BP value was achieved in only a small proportion of the patients treated with antithrombotic drugs. In patients on antithrombotic therapy, obesity appeared to be a modifiable risk factor, whereas cardiovascular comorbidities, such as heart failure, were negative factors contributing to nonachievement of the target BP.

Keywords: anticoagulant therapy; antihypertensive therapy; antiplatelet therapy; blood pressure; cardiovascular comorbidity; clinical practice; obesity.

Figure 1.

Blood pressure distribution in patients on antithrombotic therapy Blood pressure distribution was described according to the JSH 2019 guidelines. In this population, 16.5%, 14.0%, 30.3%, 29.9%, 8.0%, and 1.1% had normal BP, high-normal BP, elevated BP, grade I hypertension, grade II hypertension, and grade III hypertension, respectively.