학술논문
Novel oral anticoagulant drugs in hypertensive patients with atrial fibrillation
Expert Review
Expert Review
Document Type
Report
Source
Journal of Hypertension Research. July-Sep 2016, Vol. 2 Issue 3, p105, 9 p.
Subject
Language
English
Abstract
IntroductionHypertension (HTN) and atrial fibrillation (AF) are two major conditions that co-exist in many cardiac patients. The Novel Oral Anticoagulants (NOACs) trials have largely focused on the reduction in stroke/ [...]
Hypertension (HTN) and atrial fibrillation (AF) are two major conditions that co-exist in many cardiac patients. The Novel Oral Anticoagulants (NOACs) trials have largely focused on the reduction in stroke/ systemic embolic events (primary outcome) and the rate of intracranial hemorrhage/major bleeding/ clinically- relevant non-major (CRNM) bleeding (safety outcome), but did not account for the impact and treatment of HTN in the disease process. Subsequent studies have used the data in these large-scale trials to take a closer look at HTN and its effect on the outcome of NOACs versus warfarin. This review briefly explains the current understanding of the relationship between AF and HTN and their pathophysiology and presents the sub-trials stemming from the data in the large NOAC trials where HTN has been investigated. These trials have demonstrated non-inferiority/ superiority of NOACs in regards to warfarin is maintained, regardless of the hypertensive status of the patients and have largely shown hypertension to be a significant independent risk factor for ischemic/hemorrhagic stroke or systemic embolic events, as well as major or non-major bleeding. This is supported by the inclusion of hypertension as a risk factor in both the CHADS-VASC and the HAS-BLED score, therefore emphasizing strict control of hypertension in order to reduce cardioembolic and hemorrhagic events..Keywords: hypertension, atrial fibrillation, NOAC, dabigatran, rivaroxaban, apixaban, oral anticoagulant
Hypertension (HTN) and atrial fibrillation (AF) are two major conditions that co-exist in many cardiac patients. The Novel Oral Anticoagulants (NOACs) trials have largely focused on the reduction in stroke/ systemic embolic events (primary outcome) and the rate of intracranial hemorrhage/major bleeding/ clinically- relevant non-major (CRNM) bleeding (safety outcome), but did not account for the impact and treatment of HTN in the disease process. Subsequent studies have used the data in these large-scale trials to take a closer look at HTN and its effect on the outcome of NOACs versus warfarin. This review briefly explains the current understanding of the relationship between AF and HTN and their pathophysiology and presents the sub-trials stemming from the data in the large NOAC trials where HTN has been investigated. These trials have demonstrated non-inferiority/ superiority of NOACs in regards to warfarin is maintained, regardless of the hypertensive status of the patients and have largely shown hypertension to be a significant independent risk factor for ischemic/hemorrhagic stroke or systemic embolic events, as well as major or non-major bleeding. This is supported by the inclusion of hypertension as a risk factor in both the CHADS-VASC and the HAS-BLED score, therefore emphasizing strict control of hypertension in order to reduce cardioembolic and hemorrhagic events..Keywords: hypertension, atrial fibrillation, NOAC, dabigatran, rivaroxaban, apixaban, oral anticoagulant