ACHIEVED BLOOD PRESSURE LEVELS, COMORBIDITIES AND ONE YEAR PROGNOSIS OF ANTICOAGULATED PATIENTS WITH ATRIAL FIBRILLATION

Abstract

Objective: The aim of the study was to analyze clinical characteristics of the consecutive sample of patients with atrial fibrillation admitted to Saint Anna University Hospital, ESH Excellence center of hypertension. Design and method: Consecutive sample of 215 patients with AFib (112 M, 103 F; age 70.5) was enrolled 2017–2019. Data were collected during hospitalization and the patients were followed for one year for the occurrence of death/ischemic events and bleeding. BP was measured in a sitting position using an automatic validated device. In the present analysis we report the associations of mean achieved BP during the year (an average 6,8 BP measurements) with the key ischemic outcomes. Results: Mean CHADSVASC was 3,77 ± 1.8 and HASBLEED 2,91 ± 1,3 with 191 (88.8%) and 127 (59.1%) of patients having CHADSVASC= > 2 and HASBLEED= > 3. Arterial hypertension was the most frequent risk factor in 88.4% (average duration of 17.7 ± 9 years). Previous history of myocardial infarction or stroke, obesity, heart failure and chronic kidney disease were established in 27,9%, 23.3%, 52.6%, 79,5% and 55.8%. OAC therapy was changed in approximately 23% during the year. Average BP values were 136/84.7 mmHg at admission and mean achieved BP during the follow-up were 129.7/81.9 mmHg. The annual event rates for death/ischemic events were 19.1%, for cardiovascular death 7% and for all cause bleeding 20%. Factors, associated with subsequent ischemic events includes higher CHADSVASC (4.2 vs 3.6) and HASBLEED (3.6 vs 2.7), presence of CKD (eGFR Epi < 60 ml/min) and worsening of CKD during the year (-6.7 ml/min vs – 1 ml/min). On treatment SBP> 130 mmHg and < 110 mmHg was associated with death/ischemic events compared with SBP 120–130 mmHg, HR 2.42 (0.9–5.4) and 2.76 (1–7.6) respectively. Similar patterns were observed for DBP with an increased risk at < 70 mmHg HR 1,52 (0.9–2.56) and > 90 mmHg HR 2,31 (1,1–8.1). Factors associated with unfavorable outcomes at low achieved BP < 120/80 were the presence of ischemic heart disease, CKD or heart failure. Conclusions: The presence of comorbidities mediate the effect of blood pressure on prognosis for ischemic complications especially at low achieved levels of BP.