Elevated blood pressure a red flag for stroke, bleeding in seniors with nonvalvular AF

A systolic blood pressure (BP) of at least 145 mm Hg appears to be a strong predictor of stroke, stroke/systemic embolic events (SEE), major bleeding, and intracranial haemorrhage (ICH) in older patients with nonvalvular atrial fibrillation (AF), according to a study.

Researchers conducted a prespecified subcohort study of the ANAFIE (All Nippon AF in the Elderly) Registry. They assessed the impact of home home BP on the risk of adverse cardiovascular outcomes, including stroke/SEE, major bleeding, ICH, all-cause death, and net cardiovascular outcome (a composite of stroke/SEE and major bleeding). Home BP was measured twice in the morning and twice in the evening for 7 days.

The analysis included a total of 4,933 elderly patients (average age 81.4 years, 56.2 percent male) with nonvalvular AF. The mean CHA₂DS₂-VASc and HAS-BLED scores at baseline were 4.4 and 1.8, respectively. Most of the patients had hypertension (77.6 percent), and 93.0 percent used anticoagulants.

The mean baseline home systolic BP was 127.8 mm Hg, home diastolic BP was 72.6 mm Hg, office systolic BP was 128.4 mm Hg, and office diastolic BP was 71.3 mm Hg. Over a follow-up of 2 years, 115 stroke/SEE and 76 major bleeding events were documented. Furthermore, incidences of net cardiovascular outcome, stroke/SEE, major bleeding, and ICH increased in proportion to home systolic BP levels.

Home systolic BP ≥145 vs <125 mm Hg was significantly associated with higher risks of net cardiovascular outcome (hazard ratio [HR], 1.92, 95 percent confidence interval [CI], 1.21–3.06; p=0.006), stroke/SEE (HR, 1.88, 95 percent CI, 1.05–3.37; p=0.033), major bleeding (HR, 2.92, 95 percent CI, 1.58–5.42; p<0.001), and ICH (HR, 3.07, 95 percent CI, 1.54–6.15; p=0.002).

The association between high systolic BP and the adverse cardiovascular events was observed only among patients with at least 20 elevated systolic BP measurements.

The findings highlight the potential of strict BP control guided by the increasing number of home BP measurements in obtaining an accurate clinical outcome risk assessment.