CV Outcomes in Older Patients With NVAF and High Home SBP Treated With Warfarin

Among patients aged 75 years or older with nonvalvular atrial fibrillation (NVAF), strict blood pressure (BP) control guided by home BP may be required, regardless of the anticoagulation type used, according to a study in Hypertension Research.

The findings are based on an analysis of the home BP subcohort study of the All Nippon AF in the Elderly (ANAFIE) registry that sought to determine the incidence of clinical outcomes in elderly Japanese patients with NVAF who received oral anticoagulant (OAC) therapy (warfarin or direct oral anticoagulants [DOACs]) stratified by home BP level.

Participants were aged 75 years or older with a definitive NVAF diagnosis who could attend hospital visits and consented to measure their home BP using an oscillometric device with an arm cuff.

The study endpoints were net cardiovascular outcome (a composite of stroke/systemic embolic events [SEE] and major bleeding), stroke/SEE, major bleeding, intracranial hemorrhage (ICH), and all-cause death.

Home BP measurements were taken 4 times a day for 1 week within 60 days of enrollment. The home systolic BP (SBP) categories were: lower than 125 mm Hg, 125 to 134 mm Hg, 135 to 144 mm Hg, and 145 mm Hg or higher.

A total of 4933 patients were included, with a mean follow-up of 1.88 years. In the home SBP subgroups, 2030 participants had lower than 125 mm Hg, 1585 had 125 to 134 mm Hg, 878 had 135 to 144 mm Hg, and 440 had 145 mm Hg or higher.

The cohort’s mean age was 81.4 years and 56.2% of patients were men. Most of the participants (93%) were receiving anticoagulants, of whom 70.8% received DOACs and 22.1% received warfarin. No differences occurred in the distribution of OACs among the H-SBP groups.

For the warfarin group, the incidence rates for patients with a home SBP lower than 125 mm Hg and for patients with a home SBP of 145 mm Hg or higher were 1.91 and 5.89, respectively, for net cardiovascular outcome, 1.31 and 3.39 for stroke/SEE, 0.59 and 3.91 for major bleeding, 0.59 and 3.43 for ICH, and 4.01 and 6.24 for all-cause death. The incidence rates of net cardiovascular outcome, stroke/SEE, major bleeding, and ICH were increased significantly for patients with a home SBP of 145 mm Hg or higher vs less than 125 mm Hg (P <.05).

For the DOAC group, in patients with a home SBP of lower than 125 mm Hg and in patients with a home SBP of 145 mm Hg or higher, the incidence rates were 1.64 and 2.65, respectively, for net cardiovascular outcome, 1.00 and 1.88 for stroke/SEE, 0.78 and 1.69 for major bleeding, 0.55 and 1.31 for ICH, and 3.43 and 3.51 for all-cause death. The incidence rates of these events tended to increase with a home SBP of 145 mm Hg or higher, although no significant difference in the event rates was observed between home SBP of lower than 125 mm Hg and home SBP of 145 mm Hg or higher in the DOAC group.

The incidence rate of net cardiovascular outcome was significantly decreased in the DOAC group at a home SBP of 145 mm Hg or higher (P <.05) compared with the warfarin group.

The investigators noted that data on DOAC and warfarin use and home BP were collected at baseline only, and changes in OACs and antihypertensive drugs in the observation period were not assessed.

“Among elderly NVAF patients treated with warfarin, the incidence rates of net cardiovascular outcome, stroke/SEE, major bleeding, and ICH were significantly increased at H-SBP [home SBP] 145 mm Hg or higher vs lower than 125 mm Hg, but not in those treated with DOACs,” wrote the researchers. “Among elderly patients 75 years of age or older with NVAF who are receiving either anticoagulation with DOACs or warfarin, strict BP control guided by H-BP [home BP] may be required.”

Disclosure: This study was supported by Daiichi Sankyo Co., Ltd. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.