Hypertension prevalence but not control varies across the spectrum of risk in patients with atrial fibrillation: A RE-LY atrial fibrillation registry sub-study

Autoři: Finlay A. McAlister aff001;  Rajibul Mian aff002;  Jonas Oldgren aff003;  Lars Wallentin aff003;  Michael Ezekowitz aff004;  Salim Yusuf aff002;  Stuart J. Connolly aff002;  Jeff S. Healey aff002
Působiště autorů: Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada aff001;  Population Health Research Institute, McMaster University, Hamilton, Canada aff002;  Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden aff003;  Lankenau Institute for Medical Research, Wynnewood, PA, United States of America aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226259



Although hypertension is the most common risk factor for atrial fibrillation (AF), whether blood pressure (BP) control varies across the spectrum of stroke risk in patients with AF or by adequacy of their thromboprophylaxis management is unclear.


We examined data from the RE-LY AF registry conducted at 164 emergency departments (EDs) in 47 countries between December 2007 and October 2011.


Of the 15,400 patients in the registry, we analyzed the 9929 (mean age 67.5 years, 51.9% men) with a prior history of AF and complete BP data. While 6508 (66.5%) AF patients had hypertension, the prevalence varied widely depending on comorbidity profiles: from 45.4% in those without other cardiovascular risk factors to 82.5% in those with AF and diabetes. Although 93.9% of AF patients with hypertension were on at least one antihypertensive agent, fewer than half had BP levels ≤ 140/90 with no difference across risk profiles: 45.9% of those with NVAF and CHADS2 scores of 1 and 45.6% of those with NVAF and CHADS2 scores of 2 or more (46.9% and 45.3% for CHA2DS2-VASc scores of 1 versus 2 or more). BP control rates were not significantly better in those NVAF patients receiving guideline concordant thromboprophylaxis management (47.2%, aOR 1.03, 95%CI 0.89–1.20) than in those not receiving guideline-concordant antithrombotic therapy (45.3%).


Hypertension was common in patients with AF but BP control rates were sub-optimal and varied little across the spectrum of stroke risk or by adequacy of thromboprophylaxis. This highlights the need for an increased focus on total atherosclerotic risk rather than just thromboprophylaxis management in AF patients.

Klíčová slova:

Atrial fibrillation – Blood pressure – Cardiovascular diseases – Critical care and emergency medicine – diabetes mellitus – Hypertension – Medical risk factors – Physicians


1. McAlister FA, Campbell NRC, Zarnke K, Levine M, Graham I. The management of hypertension in Canada: a review of current guidelines, their shortcomings, and implications for the future. CMAJ. 2001;164:517–22. 11233874

2. Turner BJ, Hollenbeak CS, Weiner M, Have TT, Tang SS. Effect of unrelated comorbid conditions on hypertension management. Ann Intern Med. 2008;148:578–586. doi: 10.7326/0003-4819-148-8-200804150-00002 18413619

3. Petersen LA, Woodard LD, Henderson LM, Urech TH, Pietz K. Will hypertension performance measures used for pay-for-performance programs penalize those who care for medically complex patients? Circulation. 2009;119(23):2978–85. doi: 10.1161/CIRCULATIONAHA.108.836544 19487595

4. McAlister FA, Robitaille C, Gillespie C, Yuan K, Rao D, Grover S, et al. The impact of cardiovascular risk factor profiles on blood pressure control rates in adults from Canada and the United States. Can J Cardiol. 2013;29:598–605. doi: 10.1016/j.cjca.2012.12.004 23454038

5. Belletti D, Zacker C, Wogen J. Effect of cardiometabolic risk factors on hypertension management: a cross-sectional study among 28 physician practices in the United States. Cardiovascular Diabetology. 2010;9:7–11. doi: 10.1186/1475-2840-9-7 20122170

6. Pagidipati NJ, Navar AM, Pieper KS, Green JB, Bethel MA, Armstrong PW, et al, for the TECOS Study Group. Secondary prevention of cardiovascular disease in patients with type 2 diabetes mellitus. International insights from the TECOS Trial (Trial Evaluating Cardiovascular Outcomes with Sitagliptin). Circulation. 2017;136:1193–1203. doi: 10.1161/CIRCULATIONAHA.117.027252 28626088

7. Healey JS, Oldgren J, Ezekowitz M, Zhu J, Pais P, Wang J,et al; RE-LY Atrial Fibrillation Registry and Cohort Study Investigators. Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study. Lancet. 2016;388:1161–1169. doi: 10.1016/S0140-6736(16)30968-0 27515684

8. Chernow SM, Iserson K V, Criss E. Use of the Emergency Department for Hypertension Screening: A Prospective Study. Ann Emerg Med 1987; 16:180–182. doi: 10.1016/s0196-0644(87)80012-4 3800093

9. Backer HD, Decker L, Ackerson L. Reproducibility of increased blood pressure during an emergency department or urgent care visit. Ann Emerg Med 2003; 41:507–512 doi: 10.1067/mem.2003.151 12658251

10. Birkett NJ. The effect of alternative criteria for hypertension on estimates of prevalence and control. J Hypertens 1997;15:237–244. doi: 10.1097/00004872-199715030-00004 9468450

11. Lee S, You C-y, Kim J, Jo YH, Ro YS, Kang S-H, et al. Long-term cardiovascular risk of hypertensive events in emergency department: A population-based 10-year follow-up study. PLoS ONE 2018;13:e0191738 doi: 10.1371/journal.pone.0191738 29447174

12. Decker WW, Godwin SA, Hess EP, Lenamond CC, Jagoda AS. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients With Asymptomatic Hypertension in the Emergency Department. Ann Emerg Med 2006;47:237–249. doi: 10.1016/j.annemergmed.2005.10.003 16492490

13. Rosendaal FR, Cannegieter SC, van der Meer FJM, Briet E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost. 1993, 29:236–239.

14. White HD, Gruber M, Feyzi J, Kaatz S, Tse H, Husted S, et al. Comparison of outcomes among patients randomized to Warfarin therapy according to anticoagulant control. Arch Intern Med. 2007;167-:239–245. doi: 10.1001/archinte.167.3.239 17296878

15. Connolly SJ, Pogue J, Eikelboom J, Flaker G, Commerford P, Franzosi MG for the ACTIVE W Investigators. Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of International Normalized Ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation. 2008;118:2029–2037. doi: 10.1161/CIRCULATIONAHA.107.750000 18955670

16. Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas JL, et al, for the REACH Registry Investigators. International prevalence, recognition, and treatment for cardiovascular risk factor in outpatients with atherothrombosis. JAMA. 2006;295:180–189. doi: 10.1001/jama.295.2.180 16403930

17. Stamler J, Stamler R, Neaton JD, Wentworth D, Daviglus ML, Garside D, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy. Findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 1999;282:2012–2018. doi: 10.1001/jama.282.21.2012 10591383

18. Freedman B, Martinez C, Katholing A, Rietbrock S. Residual risk of stroke and death in anticoagulant-treated patients with atrial fibrillation. JAMA Cardiol. 2016;1:366–368. doi: 10.1001/jamacardio.2016.0393 27438123

19. Andersson OK, Almgren T, Persson B, Samuelsson O, Hedner T, Wilhelmsen L. Survival in treated hypertension: follow up study after two decades. BMJ. 1998;317:167–71. doi: 10.1136/bmj.317.7152.167 9665894

20. Gudmundsson LS, Johannsson M, Thorgeirsson G, Sigfusson N, Sigvaldason H, Witteman JC. Risk profiles and prognosis of treated and untreated hypertensive men and women in a population-based longitudinal study: the Reykjavik Study. J Hum Hypertension. 2004;18:615–622.

21. Gu Q, Burt VL, Paulose-Ram R, Yoon S, Gillum RF. High blood pressure and cardiovascular disease mortality risk among US adults: The Third National Health and Nutrition Examination Survey mortality follow-up study. Ann Epidemiol. 2008;18:302–309. doi: 10.1016/j.annepidem.2007.11.013 18261929

22. Benetos A, Thomas F, Bean KE, Guize L. Why cardiovascular mortality is higher in treated hypertensives versus subjects of the same age, in the general population. J Hypertens. 2003;21:1635–40. doi: 10.1097/00004872-200309000-00011 12923394

23. McAlister FA, Straus SE. Measurement of blood pressure: an evidence based review. BMJ. 2001;322:908–911. doi: 10.1136/bmj.322.7291.908 11302909

24. Oldgren J, Healey JS, Ezekowitz M, Commerford P, Avezum A, Pais P, et al for the RE-LY Atrial Fibrillation Registry Investigators. Variations in cause and management of atrial fibrillation in a prospective registry of 15 400 Emergency Department patients in 46 countries. The RE-LY Atrial Fibrillation Registry. Circulation. 2014;129:1568–1576. doi: 10.1161/CIRCULATIONAHA.113.005451 24463370

25. NCD Risk Factor Collaboration. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389:37–55. doi: 10.1016/S0140-6736(16)31919-5 27863813

26. McAlister FA, Wiebe N, Ronksley PE, Healey JS. Although non-stroke outcomes are more common, stroke risk scores can be used for prediction in patients with atrial fibrillation. Int J Cardiol. 2018;269:145–151. doi: 10.1016/j.ijcard.2018.07.128 30077531

27. Oduyato A, Wong CX, Hsiao AJ, Hopewell S, Altman DG, Edmin CA. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016;354:i4482. doi: 10.1136/bmj.i4482 27599725

Článek vyšel v časopise


2020 Číslo 1
Nejčtenější tento týden