Abstract 16866: Blood Pressure Control and Stroke or Bleeding Risk in Patients with Atrial Fibrillation: Results from the ROCKET AF Trial
Background: Hypertension (HTN) is a risk factor for stroke and bleeding in atrial fibrillation (AF). Yet, the association between HTN stage and stroke and bleeding risk in AF is unknown.
Methods: The study population included 14,256 of the patients randomized in the ROCKET AF trial. Baseline systolic blood pressure (SBP) and history of HTN were determined and categorized as follows: (1) no history of HTN, (2) controlled HTN (SBP <140), (3) stage 1 HTN (SBP 140-159), and (4) stage 2 HTN (SBP ≥160). Cox proportional hazards models were used to compare event rates for stroke or systemic embolism (SE) and major bleeding.
Results: Of the 90.5% of patients in ROCKET AF with HTN, 55.9% were controlled and 34.6% had stage 1 or 2 HTN. Compared with those with HTN, those without HTN had lower mean CHADS2 scores (2.8 vs. 3.5), lower rates of prior myocardial infarction (11% vs. 18%), and lower mean age (69 vs. 73 years). Compared with those with no history of HTN, there was a trend towards an increased adjusted risk of stroke or SE in patients with controlled HTN (HR 1.22, 95% CI 0.89-1.66) and stage 1 or 2 HTN (HR 1.42, 95% CI 1.03-1.95) (p=0.06). A similar trend in adjusted risk of hemorrhagic stroke (controlled HTN: HR 2.50, 95% CI 0.89-7.05; stage 1 or 2 HTN: HR 3.04, 95% CI 1.06-8.71) (p=0.11) was observed. The effect of HTN stage on stroke risk did not vary by baseline CHADS2 score (p interaction=0.70). The adjusted risk of major bleeding was not different between groups (HR 0.96, 95% CI 0.74-1.23; HR 1.00, 95% CI 0.77-1.30) (p=0.84). The benefit of rivaroxaban versus warfarin in preventing stroke or SE was consistent among patients regardless of baseline SBP (p interaction=0.69).
Conclusion: One-third of patients in a clinical trial of AF had uncontrolled SBP at baseline. Uncontrolled SBP showed a trend towards a higher risk of stroke or SE, but not bleeding. Uncontrolled SBP may be an important factor in reducing the overall risk of stroke, and specifically hemorrhagic stroke, in patients with AF.
Author Disclosures: S. Vemulapalli: Research Grant; Significant; Boston Scientific. Honoraria; Modest; Medtronic. A.S. Hellkamp: None. W. Jones: None. J.P. Piccini: Research Grant; Significant; ARCA Biopharma, GE Healthcare, Johnson & Johnson, ResMed. Consultant/Advisory Board; Modest; Johnson & Johnson, Forest Laboratories, Spectranetics, Medtronic. K.W. Mahaffey: Consultant/Advisory Board; Modest; AstraZeneca, Bayer, Bristol-Myers Squibb, Forest, Johnson & Johnson, WebMD. R.C. Becker: Consultant/Advisory Board; Modest; Bayer, Janssen, Daiichi Sankyo, Portola, Regado Biosciences, Boehringer Ingelheim. G.J. Hankey: Honoraria; Modest; Bayer, Medscape (Heart.org). S.D. Berkowitz: Employment; Significant; Bayer. G. Breithardt: Honoraria; Modest; Bayer HealthCare, BMS/Pfizer. Consultant/Advisory Board; Modest; Bayer HealthCare, BMS/Pfizer, Sanofi Aventis. D.E. Singer: Research Grant; Significant; Johnson & Johnson, Bristol-Myers Squibb. Consultant/Advisory Board; Modest; Bayer HealthCare, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Johnson & Johnson, Merck, Pfizer. K.A. Fox: Research Grant; Significant; Eli Lilly. Consultant/Advisory Board; Modest; Boehringer Ingelheim, Sanofi Aventis, AstraZeneca, Johnson & Johnson/Bayer. R.M. Califf: Research Grant; Significant; Amylin, Bristol-Myers Squibb, Eli Lilly & Co., Janssen Research & Development, Merck, Novartis. Ownership Interest; Significant; N30 Pharma, Portola. Consultant/Advisory Board; Modest; Medscape LLC/heart.org. Consultant/Advisory Board; Significant; Amgen, Novartis. M.R. Patel: Research Grant; Significant; Johnson & Johnson, AstraZeneca. Consultant/Advisory Board; Modest; Bayer, Janssen, AstraZeneca, Genzyme.
- © 2014 by American Heart Association, Inc.