부산대학교 도서관

Background: Hypertension (HTN) and atrial fibrillation (AF) commonly co-exist, and optimizing blood pressure (BP) control will reduce morbidity and mortality for this patient population. After publication of the SPRINT trial, the Canadian Hypertension Education Program (CHEP) proposed a new systolic BP (sBP) target (≤120 mmHg) for patients at high risk for cardiovascular events. The BP target for patients with diabetes was <130/<180 mmHg. Based on these recommendations, we examined the degree to which this level of BP control is observed in an AF+HTN population.Methods/Results: We enrolled 2,498 AF patients from 132community-based sites in Canada (November 2013 to March 2016) in a prospective observational registry. Blood pressure (BP) was measured as per CHEP recommendations during the baseline clinic visit. In accordance with 2016 CHEP guidelines, “high-risk” HTN patients were defined by having any of the following: clinical or subclinical cardiovascular (CV) disease; chronic kidney disease; estimated 10-year global CV risk (Framingham score) of ≥15%; age ≥75 years. There were 1791 (71.7%) patients with AF+HTN and 89.7% of them were identified as 'high-risk' for CV events based on 2016 CHEP guidelines. There were 1165 (72.5%) patients with sBP >120 mmHg. Compared to those with sBP >120mmHg, patients with sBP ≤120 mmHg were older (76.7±8.9 vs. 75.5±9.1 years, p=0.02), more likely to be male (70.8% vs. 62.8%, p<0.01), have higher CHA2DS2-VASC scores, have history of myocardial infarction (22.2% vs. 16.8%, p=0.01) and have renal impairment (eGFR<60ml/min/m (44.0% vs. 35.6%, p<0.01)). Among diabetic patients within this high-risk group, 187 (35%) of them had BP readings of <130/<80 mmHg. These patients were older and were more likely to have renal impairment when compared to diabetic patients with BP ≥130/≥80 mmHg,Conclusions: We observed that a substantial proportion of Canadian patients with AF and HTN are at 'high-risk' for cardiovascular events. Most non-diabetic patients would not meet the current more aggressive systolic BP target as recommended by CHEP. Since the 2016 CHEP guidelines were published after our registry had completed enrolment, opportunities exist to address this potential unmet need in Canadian hypertension care.