Blood pressure management for patients with atrial fibrillation

This study investigated the target blood pressure (BP) levels for patients with atrial fibrillation (AF). They found that patients with AF and BP greater than 130/80 mmHg have a higher risk of cardiovascular events.

Hypertension (high blood pressure) requires strict management to prevent complications. Hypertension can cause serious cardiovascular events (CVEs) including heart attack and stroke. Doctors use guidelines to help diagnose and select treatment for hypertension. A guideline was released in 2017 by the American College of Cardiology and American Heart Association (ACC/AHA). It recommends blood pressure (BP) greater than 130/80 mmHg be classified as type 1 hypertension. A previous guideline from the 7th Joint National Committee (JNC7) recommended a BP of 140/90 mmHg or greater as type 1 hypertension.

The ACC/AHA guideline did not make a recommendation about BP levels for patients with atrial fibrillation (AF). AF is when the atria (a chamber in the heart) is beating irregularly. This causes an abnormal heart rhythm. Many patients with AF have hypertension.

This study included 298,374 Korean patients with AF. These patients had never received anti-coagulant (blood-thinning) medication. BP was analyzed at the beginning of the study and up to 1 year later. BP levels were classified according to the 2017 ACC/AHA and JNC7 guidelines.

62.2% of patients were classified as having hypertension according to JNC7. 74.4% (62.2% from the JNC7 group and an additional 17.2%) of patients were classified as having hypertension according to 2017 ACC/AHA. The 17.2% of patients newly categorized as hypertensive had a high risk of CVEs. Newly categorized patients had a 7% increased risk of heart attack, stroke and brain hemorrhage. 

Patients with AF who were treated for hypertension who had BP levels above 130/80 mmHg had a 5-15% higher risk of CVEs. Patients who received an intensive treatment for hypertension, with BP levels below 120/80 mmHg also had a 5% higher risk of CVEs.

The authors concluded that patients with AF and BP greater than 130/80 have a higher risk of cardiovascular events.

This study only included information on Korean patients, therefore these results may not be generalized.

If you have any concerns regarding AF and BP management, please consult with your physician.