European Heart Journal Advance Access originally published online on February 8, 2007
European Heart Journal 2007 28(6):752-759; doi:10.1093/eurheartj/ehl504
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Effect of hypertension on anticoagulated patients with atrial fibrillation
1 Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK
2 AstraZeneca R&D Mölndal, SE-431 83 Mölndal, Sweden
Received 25 May 2006; revised 11 December 2006; accepted 12 January 2007; online publish-ahead-of-print 8 February 2007.
* Corresponding author. Tel: +44 121 507 5080; fax: +44 121 554 4083. E-mail address: g.y.h.lip{at}bham.ac.uk
Aim To test the hypothesis that stroke and systemic embolic events (SEE) in the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation (SPORTIF) III and V trials were related to blood pressure, and that differences in event rates (stroke and SEE, bleeding) could also be related to the degree of hypertension.
Methods and results A cross-sectional, longitudinal analysis was conducted, using data from the SPORTIF III and V trials. Results showed an increasing rate of stroke and SEE with increasing quartiles of systolic blood pressure (SBP) in AF patients. For the top quartile of SBP compared with the lowest quartile, the hazard ratio (HR) for stroke and SEE was 1.83 (95% confidence intervals [CI]: 1.22–2.74), whereas mortality was lower in the top quartile (HR 0.64; 95% CI: 0.49–0.83). In the combined SPORTIF III and V cohort, the event rate for stroke/SEE increased markedly at mean SBP of > 140 mmHg. There was no relationship between bleeding and quartiles of BP. The proportion of subjects with mean systolic BP 
140 mmHg was 35.8% (1220/3407) in SPORTIF III and 20.6% (807/3922) in SPORTIF V (P < 0.0001).
Conclusion Hypertension contributes to increased stroke and SEE in AF. Event rates markedly increase at SBP levels of 140 mmHg. The higher stroke rates observed in SPORTIF III compared with SPORTIF V may be related to the greater proportion of subjects with SBP 140 mmHg during the trial.
Key Words: Hypertension • Atrial fibrillation • Stroke • Ximelagatran • Warfarin
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