Background: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for High Blood Pressure in Adults redefined hypertension as systolic blood pressure (BP) ≥130 mm Hg or diastolic BP ≥80 mm Hg. The optimal BP for patients with atrial fibrillation (AF) is uncertain. Objectives: The goal of this study was to investigate the impacts of the 2017 ACC/AHA guideline and to determine the ideal BP threshold for the management of high BP in patients with AF. Methods: This study analyzed data for 298,374 Korean adults with oral anticoagulant–naive, nonvalvular AF obtained from the National Health Insurance Service database from 2005 to 2015. Results: According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure guideline, 62.2% of the individuals in our sample had hypertension. After applying the 2017 ACC/AHA guideline, 79.4% had hypertension, including 17.2% with newly redefined hypertension (130 to 139/80 to 89 mm Hg). Those with newly redefined hypertension had greater risks of major cardiovascular events (hazard ratio: 1.07; 95% confidence interval: 1.04 to 1.10; p < 0.001), ischemic stroke, intracranial hemorrhage, and heart failure admission, compared with nonhypertensive patients (<130/80 mm Hg). Among patients with AF undergoing hypertension treatment, patients with BP ≥130/80 mm Hg or <120/80 mm Hg were at significantly higher risks of major cardiovascular events than patients with BP of 120 to 129/<80 mm Hg. Conclusions: Patients with AF and newly redefined hypertension according to the 2017 ACC/AHA guideline were at higher risk of major cardiovascular events, suggesting that the new BP threshold is beneficial for timely diagnosis and intervention. BP of 120 to 129/<80 mm Hg was the optimal BP treatment target for patients with AF undergoing hypertension treatment.
Bibliographical noteFunding Information:
This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (NRF-2017R1A2B3003303) and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare (HI16C0058 and HI15C1200). Dr. Lip has served as a consultant for Bayer/Janssen, Bristol-Myers Squibb/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo; and as a speaker for Bayer, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
© 2018 American College of Cardiology Foundation
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine