The relationship between BP and the efficacy and safety of DOACs versus warfarin is not fully known in elderly NVAF patients in real-world clinical practice. Sub-analyses of multiple phase III clinical studies of DOACs have shown that the relative efficacy and safety of DOACs versus warfarin were consistent across all levels of systolic BP (SBP). Recently, direct oral anticoagulants (DOACs) have been used more frequently for stroke prevention in patients with NVAF in clinical practice than warfarin. A sub-cohort study of the ANAFIE Registry reported that high home blood pressure (H-BP) was associated with an increased risk of stroke/systemic embolic events (SEE), major bleeding, and intracranial hemorrhage (ICH). The All Nippon AF in the Elderly (ANAFIE) Registry was a 2-year multicenter, prospective observational study conducted to clarify the prognosis and real-world clinical status of over 30,000 elderly patients (aged ≥75 years) with non-valvular AF (NVAF). Furthermore, in patients with AF, hypertension is a risk factor for both embolism and bleeding complications and is a modifiable component of CHADS 2 and HAS-BLED scores. In patients with AF, 56.5% of patients reportedly have >1 modifiable risk factor, of which the most relevant is hypertension. These results suggest that strict BP control guided by H-BP is required in elderly NVAF patients receiving anticoagulant therapy.Ītrial fibrillation (AF) is a major risk factor for ischemic stroke, affecting the life expectancy of elderly patients. In the DOAC group, although there was no significant difference between H-SBP < 125 mmHg and ≥145 mmHg, the incidence rates of these events tended to increase at ≥145 mmHg. In warfarin-treated patients, the incidence rates of net cardiovascular outcome, stroke/SEE, major bleeding, and ICH were significantly increased at H-SBP ≥ 145 mmHg versus <125 mmHg.
In the warfarin group, at <125 mmHg and ≥145 mmHg, the respective incidence rates (per 100 person-years) were 1.91 and 5.89 for net cardiovascular outcome (a composite of stroke/systemic embolic events (SEE) and major bleeding), 1.31 and 3.39 for stroke/SEE, 0.59 and 3.91 for major bleeding, 0.59 and 3.43 for intracranial hemorrhage (ICH), and 4.01 and 6.24 for all-cause death. Of the overall ANAFIE population, 4933 patients who underwent home blood pressure (H-BP) measurements were analyzed 93% received OACs (DOACs: 3494, 70.8% warfarin: 1092, 22.1%). This sub-cohort study of the ANAFIE Registry estimated the incidence of clinical outcomes in patients receiving anticoagulant therapy (warfarin and DOACs) stratified by H-SBP levels (<125 mmHg, ≥125–<135 mmHg, ≥135–<145 mmHg and ≥145 mmHg). The benefits of direct oral anticoagulants (DOACs) and warfarin in elderly Japanese patients with non-valvular atrial fibrillation (NVAF) and high home systolic blood pressure (H-SBP) are unclear.
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