Effect of hypertension duration and blood pressure level on ischaemic stroke risk in atrial fibrillation: Nationwide data covering the entire Korean population

Tae Hoon Kim, Pil Sung Yang, Hee Tae Yu, Eunsun Jang, Hyejung Shin, Ha Yan Kim, Jae Sun Uhm, Jong Youn Kim, Jung Hoon Sung, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung, Gregory Y.H. Lip

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Aims There are a paucity of data on the association of duration of hypertension and blood pressure (BP) level with risk of ischaemic stroke in patients with atrial fibrillation (AF). Our objective was to investigate the association between duration of hypertension and secondly, BP levels with risk of ischaemic stroke among patients with AF. Methods and results A total of 246 459 oral anticoagulant-naïve non-valvular AF patients were enrolled from Korea National Health Insurance Service (NHIS) database (2005-2015). The risk of ischaemic stroke according to the duration of hypertension and systolic BP (SBP) levels were assessed. One-year increase of hypertension duration continuously increased the adjusted risk of ischaemic stroke (95% confidence interval 1.07-1.09) until 7 years, and reached a plateau with adjusted hazard ratio of 1.6. Risk of ischaemic stroke increased linearly with the increase of hypertension duration in patients younger than 65 years of age, whereas the risk reached a plateau in patients aged 65 years or older. In all baseline and pre-AF average SBP subgroups, longer duration of hypertension before AF was associated with higher ischaemic stroke risk than shorter duration of hypertension (all P-values for trends <0.01). However, the effect of long-term hypertension was not observed in patients with strictly well-controlled pre-AF average SBP of less than 120 mmHg. Conclusion The increase of hypertension duration was associated with the increased risk of ischaemic stroke. However, this long-term effect of hypertension duration can be attenuated by long-term strict SBP control throughout the entire duration of hypertension.

Original languageEnglish
Pages (from-to)809-819
Number of pages11
JournalEuropean heart journal
Volume40
Issue number10
DOIs
Publication statusPublished - 2019 Mar 7

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Atrial Fibrillation
Stroke
Blood Pressure
Hypertension
Population
National Health Programs
Korea
Anticoagulants
Databases
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kim, Tae Hoon ; Yang, Pil Sung ; Yu, Hee Tae ; Jang, Eunsun ; Shin, Hyejung ; Kim, Ha Yan ; Uhm, Jae Sun ; Kim, Jong Youn ; Sung, Jung Hoon ; Pak, Hui Nam ; Lee, Moon Hyoung ; Joung, Boyoung ; Lip, Gregory Y.H. / Effect of hypertension duration and blood pressure level on ischaemic stroke risk in atrial fibrillation : Nationwide data covering the entire Korean population. In: European heart journal. 2019 ; Vol. 40, No. 10. pp. 809-819.
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abstract = "Aims There are a paucity of data on the association of duration of hypertension and blood pressure (BP) level with risk of ischaemic stroke in patients with atrial fibrillation (AF). Our objective was to investigate the association between duration of hypertension and secondly, BP levels with risk of ischaemic stroke among patients with AF. Methods and results A total of 246 459 oral anticoagulant-na{\"i}ve non-valvular AF patients were enrolled from Korea National Health Insurance Service (NHIS) database (2005-2015). The risk of ischaemic stroke according to the duration of hypertension and systolic BP (SBP) levels were assessed. One-year increase of hypertension duration continuously increased the adjusted risk of ischaemic stroke (95{\%} confidence interval 1.07-1.09) until 7 years, and reached a plateau with adjusted hazard ratio of 1.6. Risk of ischaemic stroke increased linearly with the increase of hypertension duration in patients younger than 65 years of age, whereas the risk reached a plateau in patients aged 65 years or older. In all baseline and pre-AF average SBP subgroups, longer duration of hypertension before AF was associated with higher ischaemic stroke risk than shorter duration of hypertension (all P-values for trends <0.01). However, the effect of long-term hypertension was not observed in patients with strictly well-controlled pre-AF average SBP of less than 120 mmHg. Conclusion The increase of hypertension duration was associated with the increased risk of ischaemic stroke. However, this long-term effect of hypertension duration can be attenuated by long-term strict SBP control throughout the entire duration of hypertension.",
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Effect of hypertension duration and blood pressure level on ischaemic stroke risk in atrial fibrillation : Nationwide data covering the entire Korean population. / Kim, Tae Hoon; Yang, Pil Sung; Yu, Hee Tae; Jang, Eunsun; Shin, Hyejung; Kim, Ha Yan; Uhm, Jae Sun; Kim, Jong Youn; Sung, Jung Hoon; Pak, Hui Nam; Lee, Moon Hyoung; Joung, Boyoung; Lip, Gregory Y.H.

In: European heart journal, Vol. 40, No. 10, 07.03.2019, p. 809-819.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of hypertension duration and blood pressure level on ischaemic stroke risk in atrial fibrillation

T2 - Nationwide data covering the entire Korean population

AU - Kim, Tae Hoon

AU - Yang, Pil Sung

AU - Yu, Hee Tae

AU - Jang, Eunsun

AU - Shin, Hyejung

AU - Kim, Ha Yan

AU - Uhm, Jae Sun

AU - Kim, Jong Youn

AU - Sung, Jung Hoon

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

AU - Lip, Gregory Y.H.

PY - 2019/3/7

Y1 - 2019/3/7

N2 - Aims There are a paucity of data on the association of duration of hypertension and blood pressure (BP) level with risk of ischaemic stroke in patients with atrial fibrillation (AF). Our objective was to investigate the association between duration of hypertension and secondly, BP levels with risk of ischaemic stroke among patients with AF. Methods and results A total of 246 459 oral anticoagulant-naïve non-valvular AF patients were enrolled from Korea National Health Insurance Service (NHIS) database (2005-2015). The risk of ischaemic stroke according to the duration of hypertension and systolic BP (SBP) levels were assessed. One-year increase of hypertension duration continuously increased the adjusted risk of ischaemic stroke (95% confidence interval 1.07-1.09) until 7 years, and reached a plateau with adjusted hazard ratio of 1.6. Risk of ischaemic stroke increased linearly with the increase of hypertension duration in patients younger than 65 years of age, whereas the risk reached a plateau in patients aged 65 years or older. In all baseline and pre-AF average SBP subgroups, longer duration of hypertension before AF was associated with higher ischaemic stroke risk than shorter duration of hypertension (all P-values for trends <0.01). However, the effect of long-term hypertension was not observed in patients with strictly well-controlled pre-AF average SBP of less than 120 mmHg. Conclusion The increase of hypertension duration was associated with the increased risk of ischaemic stroke. However, this long-term effect of hypertension duration can be attenuated by long-term strict SBP control throughout the entire duration of hypertension.

AB - Aims There are a paucity of data on the association of duration of hypertension and blood pressure (BP) level with risk of ischaemic stroke in patients with atrial fibrillation (AF). Our objective was to investigate the association between duration of hypertension and secondly, BP levels with risk of ischaemic stroke among patients with AF. Methods and results A total of 246 459 oral anticoagulant-naïve non-valvular AF patients were enrolled from Korea National Health Insurance Service (NHIS) database (2005-2015). The risk of ischaemic stroke according to the duration of hypertension and systolic BP (SBP) levels were assessed. One-year increase of hypertension duration continuously increased the adjusted risk of ischaemic stroke (95% confidence interval 1.07-1.09) until 7 years, and reached a plateau with adjusted hazard ratio of 1.6. Risk of ischaemic stroke increased linearly with the increase of hypertension duration in patients younger than 65 years of age, whereas the risk reached a plateau in patients aged 65 years or older. In all baseline and pre-AF average SBP subgroups, longer duration of hypertension before AF was associated with higher ischaemic stroke risk than shorter duration of hypertension (all P-values for trends <0.01). However, the effect of long-term hypertension was not observed in patients with strictly well-controlled pre-AF average SBP of less than 120 mmHg. Conclusion The increase of hypertension duration was associated with the increased risk of ischaemic stroke. However, this long-term effect of hypertension duration can be attenuated by long-term strict SBP control throughout the entire duration of hypertension.

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