Abstract 19349: Blood Pressure Control in Community Dwelling Patients with Atrial Fibrillation: Results from the ORBIT-AF Registry
Background: Hypertension (HTN) is a risk factor for stroke and bleeding in Atrial Fibrillation (AF). We assessed the quality of systolic blood pressure (SBP) control among outpatients with AF in community practice.
Methods: The study population included 10,132 outpatients with AF enrolled in the ORBIT-AF registry from 176 practices. Baseline SBP and history of HTN were determined and categorized as follows: 1) no history of HTN 2) controlled HTN 3) stage 1 uncontrolled HTN (SBP 140-160 mmHg) and 4) stage 2 uncontrolled HTN (SBP >160 mmHg). Among patients with a history of HTN, pooled logistic regression models were constructed to generate odds ratios for predictors of uncontrolled SBP over discrete follow-up visits.
Results: Among 8383 patients with AF and HTN, 75.8% had their SBP controlled at baseline while 19.6% had stage 1 uncontrolled HTN, and 392 (4.7%) had stage 2 uncontrolled HTN. Over 2 years of follow-up, there was a mild improvement in SBP control rates; at 2 years of follow-up 79% of patients had controlled HTN, 17% had stage 1 uncontrolled HTN, and 4% had stage 2 uncontrolled HTN. Among those with baseline controlled HTN, 17% developed uncontrolled HTN of any stage and 66% of those with any baseline uncontrolled HTN achieved control. After adjusting for baseline SBP, factors associated with a failure to achieve follow-up SBP control include uncontrolled SBP at baseline (OR 3.04; 95% CI 2.69-3.43, p < .0001), female gender (OR 1.39; 95% CI 1.24-1.55, p < 0.001), history of PCI (OR 1.20; 95% CI 1.06-1.36, p=0.004), and diabetes (OR 1.16; 95% CI 1.03-1.31, p=0.016).
Conclusion: One quarter of patients with AF have uncontrolled blood pressure at baseline with only minimal improvement in overall rates of control over two years of follow-up. Females, diabetic patients, and those with a history of PCI are less likely to achieve BP control. These data suggest that opportunities remain to improve blood pressure control among those with AF in the community.
Author Disclosures: S. Vemulapalli: None. S. Kim: None. L. Thomas: None. J.P. Piccini: Research Grant; Significant; Boston Scientific, ARCA biopharma, GE healthcare, Johnson and Johnson, ResMed. Consultant/Advisory Board; Modest; Spectranetics, Johnson and Johnson. M.R. Patel: Research Grant; Significant; NHLBI, Johnson and Johnson, Astra Zeneca, AHRQ, Maquet, Tryton Medical, Medtronic. Consultant/Advisory Board; Modest; Bayer Healthcare, Genzyme, Otsuka, Jansen. P. Chang: None. G.C. Fonarow: Consultant/Advisory Board; Modest; Janssen. Consultant/Advisory Board; Significant; Novartis. M.D. Ezekowitz: Consultant/Advisory Board; Modest; Aegerion, Pozen, Coherex. Consultant/Advisory Board; Significant; Boehringer Ingelheim, Pfizer, Sanofi, Bristol Myers Squibb, PORTOLA, Bayer, Daiichi Sankyo, Medtronic, Merck, Johnson and Johnson, Gilead, Janssen. P.R. Kowey: Consultant/Advisory Board; Significant; Johnson and Johnson. K.W. Mahaffey: Research Grant; Significant; Medtronic, St. Jude. Consultant/Advisory Board; Modest; American College of Cardiology, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Elsevier, Forest, Johnson and Johnson, Medtronic, Merck, Portola Pharma, Spring Publishing, The Medicines Company, Web Med. Consultant/Advisory Board; Significant; Glaxo Smith Kline. B.J. Gersh: Consultant/Advisory Board; Modest; TEVA Pharmaceuticals, Boston Scientific, Medtronic, Baxter Healthcare, Merck, St. Jude Medical, Janssen. E.D. Peterson: Research Grant; Significant; American College of Cardiology, American Heart Association, Eli Lilly & Company, Janssen, Society of Thoracic Surgeons. Consultant/Advisory Board; Modest; Boehringer Ingelheim, Genentech, Janssen, Sanofi, Merck.
- © 2014 by American Heart Association, Inc.