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Blood pressure control and stroke or bleeding risk in anticoagulated patients with atrial fibrillation: Results from the ROCKET AF Trial.

Publication ,  Journal Article
Vemulapalli, S; Hellkamp, AS; Jones, WS; Piccini, JP; Mahaffey, KW; Becker, RC; Hankey, GJ; Berkowitz, SD; Nessel, CC; Breithardt, G; Fox, KAA ...
Published in: Am Heart J
August 2016

BACKGROUND: We conducted a retrospective analysis examining the association between systolic blood pressure (SBP) or hypertension bracket and stroke risk in patients with atrial fibrillation (AF). METHODS: The study included 14,256 anticoagulated patients in the ROCKET AF trial. Cox proportional hazards models were used to compare the risk of adverse outcomes by European Society of Cardiology hypertension bracket and screening SBP. RESULTS: In total, 90.5% of patients had hypertension (55.8% controlled, 34.6% uncontrolled). The adjusted risk of stroke or systemic embolism (SE) increased significantly for every 10-mm Hg increase in screening SBP (hazard ratio [HR] 1.07, 95% CI 1.02-1.13). There was a trend toward an increased adjusted risk of stroke or SE in patients with controlled (HR 1.22, 95% CI 0.89-1.66) and uncontrolled hypertension (HR 1.42, 95% CI 1.03-1.95) (P = .06). In contrast, the adjusted risk of major bleeding was similar between hypertensive brackets and did not vary significantly by screening SBP. The benefit of rivaroxaban versus warfarin in preventing stroke or SE was consistent among patients regardless of SBP (P interaction = .69). CONCLUSIONS: In a trial of anticoagulated patients with AF, increasing screening SBP was independently associated with stroke and SE, and one-third of patients had uncontrolled hypertension. The relative effectiveness and safety of rivaroxaban versus warfarin were consistent across all levels of screening SBP. A single SBP may be an important factor in reducing the overall risk of stroke and SE in anticoagulated patients with AF.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2016

Volume

178

Start / End Page

74 / 84

Location

United States

Related Subject Headings

  • Warfarin
  • Stroke
  • Rivaroxaban
  • Risk
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Hypertension
 

Citation

APA
Chicago
ICMJE
MLA
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Vemulapalli, S., Hellkamp, A. S., Jones, W. S., Piccini, J. P., Mahaffey, K. W., Becker, R. C., … Patel, M. R. (2016). Blood pressure control and stroke or bleeding risk in anticoagulated patients with atrial fibrillation: Results from the ROCKET AF Trial. Am Heart J, 178, 74–84. https://doi.org/10.1016/j.ahj.2016.05.001
Vemulapalli, Sreekanth, Anne S. Hellkamp, W Schuyler Jones, Jonathan P. Piccini, Kenneth W. Mahaffey, Richard C. Becker, Graeme J. Hankey, et al. “Blood pressure control and stroke or bleeding risk in anticoagulated patients with atrial fibrillation: Results from the ROCKET AF Trial.Am Heart J 178 (August 2016): 74–84. https://doi.org/10.1016/j.ahj.2016.05.001.
Vemulapalli S, Hellkamp AS, Jones WS, Piccini JP, Mahaffey KW, Becker RC, et al. Blood pressure control and stroke or bleeding risk in anticoagulated patients with atrial fibrillation: Results from the ROCKET AF Trial. Am Heart J. 2016 Aug;178:74–84.
Vemulapalli, Sreekanth, et al. “Blood pressure control and stroke or bleeding risk in anticoagulated patients with atrial fibrillation: Results from the ROCKET AF Trial.Am Heart J, vol. 178, Aug. 2016, pp. 74–84. Pubmed, doi:10.1016/j.ahj.2016.05.001.
Vemulapalli S, Hellkamp AS, Jones WS, Piccini JP, Mahaffey KW, Becker RC, Hankey GJ, Berkowitz SD, Nessel CC, Breithardt G, Singer DE, Fox KAA, Patel MR. Blood pressure control and stroke or bleeding risk in anticoagulated patients with atrial fibrillation: Results from the ROCKET AF Trial. Am Heart J. 2016 Aug;178:74–84.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2016

Volume

178

Start / End Page

74 / 84

Location

United States

Related Subject Headings

  • Warfarin
  • Stroke
  • Rivaroxaban
  • Risk
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Hypertension