Effect of hypertension on anticoagulated patients with atrial fibrillation

Lip, Gregory Y. H.; Frison, Lars; Grind, Margaretha

doi:10.1093/eurheartj/ehl504

Cited by 136 publications

(88 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…20,21 Although no relationship between the risk of bleeding and the quartiles of systolic blood pressure was observed in the SPOR-TIF cohort, the impact of blood pressure control on the risk of ischaemic stroke and bleeding events were not investigated. 19 In this study, the incidences of ischaemic stroke in hypertensive and normotensive patients were comparable when the INR control was similar between the two groups. These findings suggest that thromboembolism is related to AF rather than hypertension per se is a more important determinant of ischaemic stroke in our patient cohort with AF.…”

Section: Discussionmentioning

confidence: 51%

“…5,6 A recent analysis from the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation Trial (SPORTIF) has shown that the risk of the systemic thromboembolism and stroke in patients with non-valvular AF increased with the level of systolic blood pressure. 19 It is possible that poorly controlled blood pressure might contribute an increased risk of ischaemic stroke and bleeding, especially intracranial bleeding in patients with non-valvular AF. 20,21 Although no relationship between the risk of bleeding and the quartiles of systolic blood pressure was observed in the SPOR-TIF cohort, the impact of blood pressure control on the risk of ischaemic stroke and bleeding events were not investigated.…”

Section: Discussionmentioning

confidence: 99%

“…More importantly, among AF patients with hypertension, those who achieved target blood pressure control had a significantly lower risk of ischaemic stroke without any difference in bleeding. This is likely because anticoagulation therapy is less effective in preventing ischaemic stroke due to mechanisms other than thromboembolism, 19 and tightly controlled blood pressure might contribute to a reduced risk of ischaemic stroke related to hypertension per se. 5,6 Therefore, other than the level of anticoagulation, good control of blood pressure are equally important for the prevention of ischaemic stroke in patients with AF and hypertension.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Siu

Yue

et al. 2010

J Hum Hypertens

View full text Add to dashboard Cite

Limited evidence is available on the safety and efficacy of anticoagulants in non-valvular atrial fibrillation (AF) patients with concomitant hypertension. We investigated the safety and efficacy of 476 consecutive anticoagulated Chinese outpatients with non-valvular AF and hypertension. Occurrence of ischaemic stroke and major bleeding, and international normalized ratio (INR) values during these events were recorded. There was no significant difference in anticoagulation control between patients with or without hypertension. INRspecific incidence rates of the events were calculated, which showed no excessive risk for ischaemic stroke (2.5 vs 1.6% per year, P ¼ 0.22) or major bleeding (3.9 vs 3.2% per year, P ¼ 0.29) in non-valvular AF patients with or without hypertension. In multivariate analysis, congestive heart failure, smoking and high CHADS2 score were independent predictors for ischaemic stroke, whereas use of antiplatelet agents was an independent predictor for bleeding. It can be noted that hypertension was not associated with ischaemic stroke or major bleeding. Hypertensive patients who achieved target blood pressure control (o130/80 mm Hg) had a lower ischaemic stroke (0.9 vs 3.1% per year, P ¼ 0.01), but similar bleeding risk compared with those not achieving target blood pressure. Our findings demonstrate the effects of hypertension on the outcomes of warfarin therapy; further investigation is needed to clarify whether more aggressive antihypertensive therapy could result in better outcomes in hypertensive patients with non-valvular AF.

show abstract

Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Siu

Yue

et al. 2010

J Hum Hypertens

View full text Add to dashboard Cite

show abstract

“…Furthermore, analysis from the Stroke Prevention using an ORal Thrombin Inhibitor in Atrial Fibrillation Trial (SPORTIF) has demonstrated that level of systolic BP correlated with the risk of the systemic thromboembolism and stroke in patients with non-valvular AF. 68 Recent retrospective analysis also showed that hypertensive patients who achieved target BP control (o130/80 mm Hg) had a lower ischemic stroke (0.9% versus 3.1% per year, P ¼ 0.01), but similar bleeding risk compared with those not achieving target BP. 69 These studies highlighted the importance of achieving optimal BP control in hypertensive patients with AF to maximize the benefit of OAC therapy for stroke prevention.…”

Section: Anticoagulation Therapymentioning

confidence: 97%

Hypertension and atrial fibrillation: epidemiology, pathophysiology and therapeutic implications

Yiu

Siu

et al. 2011

J Hum Hypertens

View full text Add to dashboard Cite

Hypertension is one of the most important risk factors associated with atrial fibrillation (AF) and increased the risk of cardiovascular events in patients with AF. However, the pathophysiological link between hypertension and AF is unclear. Nevertheless, this can be explained by the hemodynamic changes of the left atrium secondary to long standing hypertension, resulting in elevated left atrium pressure and subsequently left atrial enlargement. Moreover, the activation of renin --angiotensin --aldosterone system (RAAS) activation in patients with hypertension induces left atrial fibrosis and conduction block in the left atrium, resulting in the development of AF. Accordingly, recent studies have shown that effective blockage of RAAS by angiotensin converting enzyme inhibitors or angiotensin receptor antagonist may be effective in both primary and secondary prevention of AF in patients with hypertension, although with controversies. In addition, optimal antithrombotic therapy, blood pressure control as well as rate control for AF are key to the management of patients with AF. 1,2 Both hypertension 3 and AF 4 have increased frequency with the ageing population worldwide, and are associated with increased cardiovascular events. They are important risk factors for stroke, heart failure and overall mortality. 5 --7 On the other hand, hypertension is one of the important risk factors for the occurrence of AF, 8 and increased the risk of stroke and cardiovascular mortality in patients with AF.9,10 Compare with other risk factors for AF, hypertension appears to be responsible for more AF than any other risk factor because of its high prevalence. However, the pathophysiological link between AF and hypertension remains unclear. Moreover, it is also unclear whether treatment of hypertension prevents AF or reduces the risk of AF related complications. The purpose of this article is to review the epidemiology, underlying mechanisms and therapeutic implications of AF in hypertensive patients. A systematic literature search for full-text papers in the English language was performed using MEDLINE, Embase and the Cochrane library through to July 2011. In the search phrases used, the following terms were used: 'atrial fibrillation', 'hypertension', 'epidemiology', 'pathophysiology' and 'treatment'. Papers selected and cited in this review were based on the authors' view on the relevance to the manuscript. In addition, abstracts from international cardiovascular meetings were studied to identify unpublished studies.

show abstract

“…2 There is suggestive evidence that the risk-adjusted incidence of cardioembolic ischemic stroke in patients with atrial fibrillation has declined over the past 2 decades, perhaps in response to more aggressive treatment of underlying risk factors such as hypertension and hyperlipidemia. [3][4][5] As a result, the balance between the risk and benefit of anticoagulation therapy in patients with non-valvular atrial fibrillation may be shifting. These two trends, the increasing incidence of warfarin-associated ICH and the decreasing risk of cardioembolic ischemic stroke in patients with AF, underscore the imperative to develop better tools to predict the risk of warfarin-associated ICH to improve "personalized" decision-making about anticoagulant therapy for patients with AF.…”

mentioning

confidence: 99%

Testing for CYP2C9 Before Anticoagulant Therapy

2009

View full text Add to dashboard Cite

A uthors Reply: We share Dr. Jolobe's sentiment that appropriate tools must be developed to better characterize the risk of bleeding, particularly intracerebral hemorrhage, for patients with indications for oral anticoagulant therapy. Indeed, the increased use of warfarin anticoagulation for prevention of thromboembolic stroke in patients with atrial fibrillation (AF) has produced significant benefits, but has also resulted in an estimated quintupling of the incidence of warfarin-associated intracerebral hemorrhage (ICH).1 Warfarin-associated ICH now comprises roughly 20% of all ICH. Furthermore, among patients with ICH, warfarin is associated with a doubling in the case fatality rate at 3 months and an increase in poor neurological outcomes. 2 There is suggestive evidence that the risk-adjusted incidence of cardioembolic ischemic stroke in patients with atrial fibrillation has declined over the past 2 decades, perhaps in response to more aggressive treatment of underlying risk factors such as hypertension and hyperlipidemia. [3][4][5] As a result, the balance between the risk and benefit of anticoagulation therapy in patients with non-valvular atrial fibrillation may be shifting. These two trends, the increasing incidence of warfarin-associated ICH and the decreasing risk of cardioembolic ischemic stroke in patients with AF, underscore the imperative to develop better tools to predict the risk of warfarin-associated ICH to improve "personalized" decision-making about anticoagulant therapy for patients with AF. Dr. Jolobe mentioned several possible risk markers for warfarin-associated ICH, including genetic risk factors such as apolipoprotein E and imaging studies such as MRI and CT scanning. Indeed, in a previous publication we explored whether screening strategies that include genetic profiling and neuroimaging might improve the safety of chronic anticoagulation for atrial fibrillation by identifying individuals from whom warfarin should be withheld or for whom aspirin might be a better treatment.6 Unfortunately, we found that currently identified genetic markers of bleeding risk, such as Apo є 2 or 4 do not confer a risk of ICH sufficiently high to warrant routine genetic testing for patients at average risk of thromboembolism. We did find that for patients at lower risk for cardioembolic stroke, screening with gradient echo MRI would be beneficial if the risk conferred by neuroimaging evidence of cerebral microhemorrhage were greater than 3.2-fold, a number somewhat higher than current estimates. 7 Although studies will require large numbers of patients, given the infrequency of ICH, it is imperative that trials be performed to better characterize the risk of future ICH associated with findings such as cerebral microhemorrhage or possibly novel genetic markers we have yet to identify.

show abstract

Effect of hypertension on anticoagulated patients with atrial fibrillation

Cited by 136 publications

References 15 publications

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Hypertension and atrial fibrillation: epidemiology, pathophysiology and therapeutic implications

Testing for CYP2C9 Before Anticoagulant Therapy

Contact Info

Product

Resources

About