Should atrial fibrillation patients with hypertension as an additional risk factor of the CHA2DS2-VASc score receive oral anticoagulation?

Abstract

Hypertension has been found to be increased a risk of stroke in atrial fibrillation (AF). Both the European and U.S. guidelines advocate the use of the CHA2DS2-VASc (congestive heart failure, hypertension, age > 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65–74 years, sex category) scheme for risk stratification. Although vitamin K antagonists is more effective than acetylsalicylic acid at preventing ischaemic stroke, its benefit is offs by an increased haemorrhage risk. The risk of ischemic stroke in patients with AF and a CHA2DS2-VASc score of 1 are considered to be low risk and may be not expected to benefit from anticoagulation therapy. Hypertension carries an increased risk of ischemic stroke, however, it is also a clear risk factor for hemorrhage in AF. Therefore, the optimal antithrombotic management is highlighted in patients with AF with only one risk factor especially hypertension.