한빛사 논문
Tae-Hoon Kim1†, Pil-Sung Yang2†, Hee Tae Yu1, Eunsun Jang1, Hyejung Shin3, Ha Yan Kim3, Jae-Sun Uhm1, Jong-Youn Kim1, Jung-Hoon Sung2, Hui-Nam Pak1, Moon-Hyoung Lee1, Boyoung Joung1*‡, and Gregory Y.H. Lip1,4,5*‡
1 Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, 03722, Republic of Korea; 2 Department of Cardiology, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13496, Republic of Korea; 3 Department of Biomedical Systems Informatics, Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, 03722, Republic of Korea; 4 Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; and 5 Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L69 3BX, UK
† The first two authors contributed equally to this work.
‡ The last two authors are joint senior authors.
*Corresponding author.
Abstract
Aims
There are a paucity of data on the association of duration of hypertension and blood pressure (BP) level with risk of ischaemic stroke in patients with atrial fibrillation (AF). Our objective was to investigate the association between duration of hypertension and secondly, BP levels with risk of ischaemic stroke among patients with AF.
Methods and results
A total of 246 459 oral anticoagulant-naive non-valvular AF patients were enrolled from Korea National Health Insurance Service (NHIS) database (2005-2015). The risk of ischaemic stroke according to the duration of hypertension and systolic BP (SBP) levels were assessed. One-year increase of hypertension duration continuously increased the adjusted risk of ischaemic stroke (95% confidence interval 1.07-1.09) until 7 years, and reached a plateau with adjusted hazard ratio of 1.6. Risk of ischaemic stroke increased linearly with the increase of hypertension duration in patients younger than 65-years of age, whereas the risk reached a plateau in patients aged 65-years or older. In all baseline and pre-AF average SBP subgroups, longer duration of hypertension before AF was associated with higher ischaemic stroke risk than shorter duration of hypertension (all P-values for trends <0.01). However, the effect of long-term hypertension was not observed in patients with strictly well-controlled pre-AF average SBP of less than 120 mmHg.
Conclusion
The increase of hypertension duration was associated with the increased risk of ischaemic stroke. However, this long-term effect of hypertension duration can be attenuated by long-term strict SBP control throughout the entire duration of hypertension.
Keywords : Atrial fibrillation, Hypertension, Ischaemic stroke, Duration, Blood pressure
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