Abstract 11087: Benefits of Dabigatran versus Warfarin in Hypertensive Patients With Atrial Fibrillation: Results From The Re-ly Trial
Background: HT is frequent among patients with AF. The RE-LY trial permits a contemporary evaluation of comorbidities, outcomes, and the effectiveness of dabigatran in this important sub-group of patients with AF.
METHODS: Patient characteristics and outcomes were compared between patients diagnosed with and without controlled HT at trial entry, and the relative efficacy of each dose of dabigatran versus warfarin was analysed. Significant interactions with treatment were evaluated.
RESULTS: Of 18,113 patients in RE-LY, 14,283 patients (78.9%) had controlled HT (SBP ≤ 180mmHg and DBP ≤ 100mmHg). Patients with HT were older (71.6 vs 70.9 years, ns), more likely to have diabetes mellitus (25.6 vs 14.8%, p < 0.001), more likely to be female (38.6 vs 28.3%, p < 0.001), had higher CHADS2 (2.3 vs 1.4, p < 0.001) and CHADS-VASc (3.8 vs 2.8, p < 0.001), but had heart failure and prior stroke/SEE/TIA less often (30.7 vs 36.9% for heart failure, p < 0.001; 21.2 vs 24.3% for prior stroke/SEE/TIA, p < 0.05) compared to patients without HT. The mean blood pressure at baseline was 132.6/77.7 mmHg in hypertensives vs 124.8/74.6 mmHg in nonhypertensives (p < 0.001). The relative benefits of dabigatran compared to warfarin were similar in patients with compared to without HT (see table; all p values for interaction = ns).
Conclusions: AF patients with HT in RE-LY were more likely to be female, had a higher prevalence of diabetes mellitus, and higher CHADS2 and CHADS-VASc, the latter facilitated by the fact that HT provides one point in the CHADS and CHADS-VASc scoring system. Differences in stroke and other event rates appear surprisingly small between patients with and without HT, which may be explained by the study inclusion criteria, requesting at least one other qualifying stroke risk factor in non-HT patients. Compared to nonhypertensives, patients with HT derive similar relative benefits of dabigatran over warfarin, including a substantial reduction of intracranial hemorrhage.
- © 2013 by American Heart Association, Inc.