What is the optimal BP level for AF patients on DOAC therapy?

Systolic blood pressure (SBP) values <161 mm Hg appear to increase the risk of all-cause mortality but reduce event risk in patients with atrial fibrillation (AF) treated with direct oral anticoagulants (DOACs), suggests a study. The nadir SBP for lowest event rate is 120 mm Hg, for lowest cardiovascular mortality 130 mm Hg, and for lowest all-cause mortality 160 mm Hg.

A 10-mm Hg increase in SBP did not induce a significant difference in the Cox proportional hazard ratio (HR) of an event (crude and adjusted HR, 1.04, 95 percent confidence interval [CI], 1.00–1.08; p=0.077 and p=0.071, respectively).

Furthermore, a 10-mm Hg increase in SBP showed an inverse association with the risks of all-cause mortality (crude HR, 0.83, 95 percent CI, 0.80–0.86; p=0.000; adjusted HR, 0.84, 95 percent CI, 0.81–0.87; p=0.000) and cardiovascular mortality (crude HR, 0.92, 95 percent CI, 0.85–0.99; p=0.021; adjusted HR, 0.93, 95 percent CI, 0.86–1.00; p=0.041).

The lowest rate of all-cause mortality was observed among patients with SBP within 161–210 mm Hg, while the lowest cardiovascular death rate was seen in those with SBP within 121–140 mm Hg.

“This demonstrates a need for a prospective interventional study of BP control after initiation of anticoagulation,” the investigators said.

A total of 9,051 primary care patients in England on DOACs for AF with postinitiation BP levels available within the Clinical Practice Research Datalink had their SBP measured in this study.

The investigators then calculated the incidence rate for the primary outcome of the first recorded event (defined as a diagnosis of first stroke, recurrent stroke, myocardial infarction, symptomatic intracranial bleed, or significant gastrointestinal bleed) and of secondary outcomes all-cause mortality and cardiovascular mortality by postinitiation BP groups.