Ideal Blood Pressure in Patients With Atrial Fibrillation

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

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)1233-1245
Number of pages13
JournalJournal of the American College of Cardiology
Volume72
Issue number11
DOIs
Publication statusPublished - 2018 Sep 11

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Atrial Fibrillation
Blood Pressure
Hypertension
American Heart Association
Guidelines
Cardiology
National Health Programs
Intracranial Hemorrhages
Therapeutics
Heart Failure
Stroke
Databases
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kim, D., Yang, P. S., Kim, T. H., Jang, E., Shin, H., Kim, H. Y., ... Lip, G. Y. H. (2018). Ideal Blood Pressure in Patients With Atrial Fibrillation. Journal of the American College of Cardiology, 72(11), 1233-1245. https://doi.org/10.1016/j.jacc.2018.05.076
Kim, Daehoon ; Yang, Pil Sung ; Kim, Tae Hoon ; Jang, Eunsun ; Shin, Hyejung ; Kim, Ha Yan ; Yu, Hee Tae ; Uhm, Jae Sun ; Kim, Jong Youn ; Pak, Hui Nam ; Lee, Moon Hyoung ; Joung, Boyoung ; Lip, Gregory Y.H. / Ideal Blood Pressure in Patients With Atrial Fibrillation. In: Journal of the American College of Cardiology. 2018 ; Vol. 72, No. 11. pp. 1233-1245.
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title = "Ideal Blood Pressure in Patients With Atrial Fibrillation",
abstract = "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.",
author = "Daehoon Kim and Yang, {Pil Sung} and Kim, {Tae Hoon} and Eunsun Jang and Hyejung Shin and Kim, {Ha Yan} and Yu, {Hee Tae} and Uhm, {Jae Sun} and Kim, {Jong Youn} and Pak, {Hui Nam} and Lee, {Moon Hyoung} and Boyoung Joung and Lip, {Gregory Y.H.}",
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Kim, D, Yang, PS, Kim, TH, Jang, E, Shin, H, Kim, HY, Yu, HT, Uhm, JS, Kim, JY, Pak, HN, Lee, MH, Joung, B & Lip, GYH 2018, 'Ideal Blood Pressure in Patients With Atrial Fibrillation', Journal of the American College of Cardiology, vol. 72, no. 11, pp. 1233-1245. https://doi.org/10.1016/j.jacc.2018.05.076

Ideal Blood Pressure in Patients With Atrial Fibrillation. / Kim, Daehoon; Yang, Pil Sung; Kim, Tae Hoon; Jang, Eunsun; Shin, Hyejung; Kim, Ha Yan; Yu, Hee Tae; Uhm, Jae Sun; Kim, Jong Youn; Pak, Hui Nam; Lee, Moon Hyoung; Joung, Boyoung; Lip, Gregory Y.H.

In: Journal of the American College of Cardiology, Vol. 72, No. 11, 11.09.2018, p. 1233-1245.

Research output: Contribution to journalArticle

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T1 - Ideal Blood Pressure in Patients With Atrial Fibrillation

AU - Kim, Daehoon

AU - Yang, Pil Sung

AU - Kim, Tae Hoon

AU - Jang, Eunsun

AU - Shin, Hyejung

AU - Kim, Ha Yan

AU - Yu, Hee Tae

AU - Uhm, Jae Sun

AU - Kim, Jong Youn

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

AU - Lip, Gregory Y.H.

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Y1 - 2018/9/11

N2 - 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.

AB - 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.

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