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Risk of stroke and bleeding in relation to hypertension in anticoagulated patients with atrial fibrillation: a meta-analysis of randomised controlled trials.

Publication ,  Journal Article
Harskamp, RE; Lucassen, WAM; Lopes, RD; Himmelreich, JCL; Parati, G; Weert, HCPMV
Published in: Acta Cardiol
May 2022

BACKGROUND AND PURPOSE: Hypertension is common in patients with atrial fibrillation (AF) and carries an additional risk for complications, most notably stroke and bleeding. We assessed the history of hypertension, level of blood pressure control, and an interaction with the choice of oral anticoagulants on clinical outcomes. METHODS: We performed a systematic review and meta-analysis of studies that randomised patients to novel oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) and reported outcomes stratified by presence of hypertension. Collected outcomes were: ischaemic stroke or systemic embolism (SE), haemorrhagic stroke, intracranial haemorrhage and major bleeding. Log adjusted hazard ratios (HR) and corresponding standard error were calculated, and HRs were compared using Mantel-Haenszel random effects. Quality of the evidence was assessed with Cochrane risk of bias tool. RESULTS: Five high-quality studies were eligible, including 71.527 participants who received NOACs (apixaban, dabigatran, edoxaban, rivaroxaban) or VKAs, with median follow-up of 1.8-2.8 years. Compared with patients without hypertension, those with hypertension had higher adjusted risk for ischaemic stroke/SE (HR: 1.25, 95%-CI:1.09, 1.43) and haemorrhagic stroke (HR:1.98, 1.24-3.16). On a continuous scale, the risk of ischaemic stroke/SE increased 6-7% per 10 mmHg increase in systolic blood pressure. No interactions were found between the efficacy or safety of NOACs versus VKAs in the presence or absence of hypertension. In both groups, the use of NOACs led to a lower risk of ischaemic stroke/SE, haemorrhagic stroke and intracranial haemorrhage compared with patients that used VKAs. CONCLUSIONS: Adequate blood pressure management is vital to optimally reduce the risk of stroke in patients with atrial fibrillation. The benefits of NOACs over VKAs, also apply to patients with elevated blood pressure.

Duke Scholars

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Published In

Acta Cardiol

DOI

EISSN

1784-973X

Publication Date

May 2022

Volume

77

Issue

3

Start / End Page

191 / 195

Location

England

Related Subject Headings

  • Vitamin K
  • Stroke
  • Ischemic Stroke
  • Intracranial Hemorrhages
  • Hypertension
  • Humans
  • Hemorrhagic Stroke
  • Hemorrhage
  • Embolism
  • Cardiovascular System & Hematology
 

Citation

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Harskamp, R. E., Lucassen, W. A. M., Lopes, R. D., Himmelreich, J. C. L., Parati, G., & Weert, H. C. P. M. V. (2022). Risk of stroke and bleeding in relation to hypertension in anticoagulated patients with atrial fibrillation: a meta-analysis of randomised controlled trials. Acta Cardiol, 77(3), 191–195. https://doi.org/10.1080/00015385.2021.1882111
Harskamp, Ralf E., Wim A. M. Lucassen, Renato D. Lopes, Jelle C. L. Himmelreich, Gianfranco Parati, and Henk CPM van Weert. “Risk of stroke and bleeding in relation to hypertension in anticoagulated patients with atrial fibrillation: a meta-analysis of randomised controlled trials.Acta Cardiol 77, no. 3 (May 2022): 191–95. https://doi.org/10.1080/00015385.2021.1882111.
Harskamp RE, Lucassen WAM, Lopes RD, Himmelreich JCL, Parati G, Weert HCPMV. Risk of stroke and bleeding in relation to hypertension in anticoagulated patients with atrial fibrillation: a meta-analysis of randomised controlled trials. Acta Cardiol. 2022 May;77(3):191–5.
Harskamp, Ralf E., et al. “Risk of stroke and bleeding in relation to hypertension in anticoagulated patients with atrial fibrillation: a meta-analysis of randomised controlled trials.Acta Cardiol, vol. 77, no. 3, May 2022, pp. 191–95. Pubmed, doi:10.1080/00015385.2021.1882111.
Harskamp RE, Lucassen WAM, Lopes RD, Himmelreich JCL, Parati G, Weert HCPMV. Risk of stroke and bleeding in relation to hypertension in anticoagulated patients with atrial fibrillation: a meta-analysis of randomised controlled trials. Acta Cardiol. 2022 May;77(3):191–195.

Published In

Acta Cardiol

DOI

EISSN

1784-973X

Publication Date

May 2022

Volume

77

Issue

3

Start / End Page

191 / 195

Location

England

Related Subject Headings

  • Vitamin K
  • Stroke
  • Ischemic Stroke
  • Intracranial Hemorrhages
  • Hypertension
  • Humans
  • Hemorrhagic Stroke
  • Hemorrhage
  • Embolism
  • Cardiovascular System & Hematology