Hypertension prevalence but not control varies across the spectrum of risk in patients with atrial fibrillation: A RE-LY atrial fibrillation registry sub-study

Finlay A Mcalister,Lars Wallentin,Rajibul Mian,Jonas Oldgren,Stuart J Connolly,Salim Yusuf,For The Re-Ly Atrial Fibrillation Registry Investigators ,Michael Ezekowitz,Jeff S Healey

doi:10.1371/journal.pone.0226259

Abstract

BackgroundAlthough hypertension is the most common risk factor for atrial fibrillation (AF), whether blood pressure (BP) control varies across the spectrum of stroke risk in patients with AF or by adequacy of their thromboprophylaxis management is unclear.MethodsWe examined data from the RE-LY AF registry conducted at 164 emergency departments (EDs) in 47 countries between December 2007 and October 2011.ResultsOf the 15,400 patients in the registry, we analyzed the 9929 (mean age 67.5 years, 51.9% men) with a prior history of AF and complete BP data. While 6508 (66.5%) AF patients had hypertension, the prevalence varied widely depending on comorbidity profiles: from 45.4% in those without other cardiovascular risk factors to 82.5% in those with AF and diabetes. Although 93.9% of AF patients with hypertension were on at least one antihypertensive agent, fewer than half had BP levels ≤ 140/90 with no difference across risk profiles: 45.9% of those with NVAF and CHADS2 scores of 1 and 45.6% of those with NVAF and CHADS2 scores of 2 or more (46.9% and 45.3% for CHA2DS2-VASc scores of 1 versus 2 or more). BP control rates were not significantly better in those NVAF patients receiving guideline concordant thromboprophylaxis management (47.2%, aOR 1.03, 95%CI 0.89–1.20) than in those not receiving guideline-concordant antithrombotic therapy (45.3%).ConclusionsHypertension was common in patients with AF but BP control rates were sub-optimal and varied little across the spectrum of stroke risk or by adequacy of thromboprophylaxis. This highlights the need for an increased focus on total atherosclerotic risk rather than just thromboprophylaxis management in AF patients.

Highlights

Multimorbidity is common, cardiovascular (CV) guidelines traditionally emphasize the treatment and attainment of “target levels” for individual risk factors such as hypertension, dyslipidemia, or dysglycemia which differ depending on their other comorbidities like diabetes or chronic kidney disease but without regard for other cardiovascular conditions such as atrial fibrillation.[1]
We examined data from the RE-LY atrial fibrillation (AF) registry conducted at 164 emergency departments (EDs) in 47 countries between December 2007 and October 2011
Hypertension was common in patients with AF but blood pressure (BP) control rates were sub-optimal and varied little across the spectrum of stroke risk or by adequacy of thromboprophylaxis

Summary

Introduction

Cardiovascular (CV) guidelines traditionally emphasize the treatment and attainment of “target levels” for individual risk factors such as hypertension, dyslipidemia, or dysglycemia which differ depending on their other comorbidities like diabetes or chronic kidney disease but without regard for other cardiovascular conditions such as atrial fibrillation.[1] The interplay between the presence of other CV risk factors and control rates for each condition is unclear as studies have reported conflicting results.[2,3,4,5,6] In a prior publication from the RE-LY AF registry cohort, we reported that 62% of patients presenting to emergency departments (EDs) with atrial fibrillation or flutter had hypertension (varying from 42% in India to 81% in Eastern Europe) and that 65% of those with hypertension had controlled blood pressure (BP) levels (varying from 56% in North America and Western Europe to 78% in India).[7] For the purposes of this study, we wanted to explore whether hypertension prevalence and BP treatment and control rates differed by CV risk profiles, CHADS2 scores, or thromboprophylaxis management in patients presenting to EDs with preexisting atrial fibrillation (AF). Hypertension is the most common risk factor for atrial fibrillation (AF), whether blood pressure (BP) control varies across the spectrum of stroke risk in patients with AF or by adequacy of their thromboprophylaxis management is unclear.

Methods

Results

Conclusion