Blood pressure. The forgotten factor in previous and recent studies regarding anticoagulation in atrial fibrillation

Atrial fibrillation is an independent risk factor for stroke and thromboembolic events . For several years the anticoagulation was principally limited to vitamine K antagonists (VKA). It was an effective drug with advantages but also disadvantages like variable response and the need for periodically INR monitoring. This has led the pharmaceutical industry to the development of newer oral anticoagulants at least as effective (or more effective) as VKAs, with lower (or similar, depending the dose) risk of bleeding and a convenient dosing regiment without the need for INR monitoring. Several studies published recently like ROCKET-AF, RELY, AVERROES and ARISTOTLE showed the superiority (or non inferiority) of newer anticoagulants versus VKA, reducing the risk of stroke and major bleedings, using a drug regiment easiest and apparently safer. However in reading these studies, we become aware that the authors didn't take into consideration the blood pressure levels in those patients during follow-up. Looking buck in the literature we realized that in all previous studies regarding VKAs in atrial fibrillation, blood pressure during follow-up wasn't considered (). The prevalence of hypertensive patients in those trials was extremely high and ranged from 50% to 90% . Arterial hypertension is an established risk factor for stroke and antihypertensive therapy reduce the risk of stroke from 30% to 40% . More over hypertension is associated with high risk of serious bleeding . Among the cl...
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Letters to the Editor Source Type: research