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Blood Pressure Control and Cardiovascular Outcomes in Patients With Atrial Fibrillation (From the ORBIT-AF Registry).

Publication ,  Journal Article
Vemulapalli, S; Inohara, T; Kim, S; Thomas, L; Piccini, JP; Patel, MR; Chang, P; Fonarow, GC; Ezekowitz, MD; Hylek, E; Go, AS; Kowey, PR ...
Published in: Am J Cardiol
May 15, 2019

Systolic blood pressure (SBP) and its association with clinical outcomes in atrial fibrillation (AF) patients in community practice are poorly characterized. In patients with AF, we sought to (1) examine the prevalence of baseline uncontrolled hypertension and the overall change in SBP control, (2) identify predictors of uncontrolled SBP over 2 years of follow-up, and (3) determine the relation between SBP and clinical outcomes. We analyzed 10,132 patients with AF at 176 clinics in the ORBIT-AF registry between 2010 and 2014, classified as: (1) no history of hypertension; (2) controlled hypertension (baseline SBP <140 mm Hg); (3) and uncontrolled hypertension (baseline SBP >140 mm Hg). Predictors of SBP >140 mm Hg at baseline or in follow-up were identified with pooled logistic regression. Random effects Cox regression models were used to compare cardiovascular outcomes and major bleeding as a function of continuous, time-dependent SBP. Overall 8,383 (83%) of patients with AF had hypertension. Of these, 24.2% (n = 2032) had uncontrolled baseline SBP, with little change over 2 years. Predictors of elevated follow-up SBP included uncontrolled baseline SBP, females, previous percutaneous coronary intervention, and diabetes. For every 5 mm Hg increase in follow-up SBP, the adjusted risk of stroke or systemic embolism or transient ischemic attack (adjusted hazard ratio [aHR] 1.05, 95% confidence interval [CI] 1.01 to 1.08, p = 0.01), myocardial infarction (aHR 1.05, 95% CI 1.00 to 1.11, p = 0.04), and major bleeding (aHR 1.03, 95% CI 1.00 to 1.06, p = 0.04) increased modestly. In conclusion, in patients with AF, higher SBP was associated with increasing adverse events; therefore, more rigorous blood pressure control should be emphasized.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

May 15, 2019

Volume

123

Issue

10

Start / End Page

1628 / 1636

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Registries
  • Prognosis
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Cardiovascular System & Hematology
  • Cardiovascular Diseases
 

Citation

APA
Chicago
ICMJE
MLA
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Vemulapalli, S., Inohara, T., Kim, S., Thomas, L., Piccini, J. P., Patel, M. R., … Peterson, E. D. (2019). Blood Pressure Control and Cardiovascular Outcomes in Patients With Atrial Fibrillation (From the ORBIT-AF Registry). Am J Cardiol, 123(10), 1628–1636. https://doi.org/10.1016/j.amjcard.2019.02.010
Vemulapalli, Sreekanth, Taku Inohara, Sunghee Kim, Laine Thomas, Jonathan P. Piccini, Manesh R. Patel, Paul Chang, et al. “Blood Pressure Control and Cardiovascular Outcomes in Patients With Atrial Fibrillation (From the ORBIT-AF Registry).Am J Cardiol 123, no. 10 (May 15, 2019): 1628–36. https://doi.org/10.1016/j.amjcard.2019.02.010.
Vemulapalli S, Inohara T, Kim S, Thomas L, Piccini JP, Patel MR, et al. Blood Pressure Control and Cardiovascular Outcomes in Patients With Atrial Fibrillation (From the ORBIT-AF Registry). Am J Cardiol. 2019 May 15;123(10):1628–36.
Vemulapalli, Sreekanth, et al. “Blood Pressure Control and Cardiovascular Outcomes in Patients With Atrial Fibrillation (From the ORBIT-AF Registry).Am J Cardiol, vol. 123, no. 10, May 2019, pp. 1628–36. Pubmed, doi:10.1016/j.amjcard.2019.02.010.
Vemulapalli S, Inohara T, Kim S, Thomas L, Piccini JP, Patel MR, Chang P, Fonarow GC, Ezekowitz MD, Hylek E, Go AS, Kowey PR, Mahaffey KW, Gersh BJ, Peterson ED. Blood Pressure Control and Cardiovascular Outcomes in Patients With Atrial Fibrillation (From the ORBIT-AF Registry). Am J Cardiol. 2019 May 15;123(10):1628–1636.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

May 15, 2019

Volume

123

Issue

10

Start / End Page

1628 / 1636

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Registries
  • Prognosis
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Cardiovascular System & Hematology
  • Cardiovascular Diseases