Dataset Information

Diastolic blood pressure achieved at target systolic blood pressure (120-140 mm Hg) and dabigatran-related bleeding in patients with nonvalvular atrial fibrillation: A real-world study.

ABSTRACT: OBJECTIVE:Elevated systolic blood pressure (SBP) can significantly increase the bleeding risk in patients with atrial fibrillation (AF). However, it is unclear whether elevated diastolic blood pressure (DBP), in the presence of well-controlled SBP is also associated with bleeding. Therefore, we aimed to examine the specific relationship between DBP and bleeding in patients with AF treated with anticoagulants and had well-controlled SBP. METHODS:We analyzed data from 542 of 929 patients with nonvalvular AF (NVAF) treated with dabigatran from the Monitor System for the Safety of Dabigatran Treatment study (MISSION-AF) who had a SBP of 120-140 mm Hg at the time of enrollment. The association between DBP and bleeding was analyzed using multivariate logistic regression and smooth curve fitting (penalized spline method). Threshold saturation effect analysis was used to show the nonlinear relationship between DBP and bleeding. RESULTS:After 3 months of follow-up, 49 bleeding events occurred. Compared with participants with DBP <80 mm Hg, those with DBP ?80 mm Hg had a 118% higher bleeding risk [hazard ratio (HR): 2.18; 95% confidence interval (CI): 1.19, 3.98; p<0.05]. The smooth curve showed a nonlinear relationship between DBP and bleeding risk, and the inflection point of DBP was 80 mm Hg. When DBP was ?80 mm Hg, the bleeding risk increased by 59% (HR: 1.59; 95% CI: 1.16, 2.19; p<0.05) for every 5 mm Hg increase in DBP. CONCLUSION:Upon achieving an optimal SBP (120-140 mm Hg), a higher DBP might be associated with a higher bleeding risk in patients with NVAF treated with dabigatran.

SUBMITTER: Yu Y

PROVIDER: S-EPMC7585965 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Diastolic blood pressure achieved at target systolic blood pressure (120-140 mm Hg) and dabigatran-related bleeding in patients with nonvalvular atrial fibrillation: A real-world study.

Yu Yu Y Li Minghui M Zhou Wei W Wang Tao T Zhu Lingjuan L Hu Lihua L Bao Huihui H Cheng Xiaoshu X

Anatolian journal of cardiology 20201001 4

<h4>Objective</h4>Elevated systolic blood pressure (SBP) can significantly increase the bleeding risk in patients with atrial fibrillation (AF). However, it is unclear whether elevated diastolic blood pressure (DBP), in the presence of well-controlled SBP is also associated with bleeding. Therefore, we aimed to examine the specific relationship between DBP and bleeding in patients with AF treated with anticoagulants and had well-controlled SBP.<h4>Methods</h4>We analyzed data from 542 of 929 pat ...[more]

PMID: 33001045

Similar Datasets

Project description:BACKGROUND:Data from before the 2000s indicate that the majority of incident cardiovascular disease (CVD) events occur among US adults with systolic and diastolic blood pressure (SBP/DBP) ?140/90 mm?Hg. Over the past several decades, BP has declined and hypertension control has improved. METHODS:We estimated the percentage of incident CVD events that occur at SBP/DBP <140/90 mm?Hg in a pooled analysis of 3 contemporary US cohorts: the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), the MESA (Multi-Ethnic Study of Atherosclerosis), and the JHS (Jackson Heart Study) (n=31?856; REGARDS=21?208; MESA=6779; JHS=3869). Baseline study visits were conducted in 2003 to 2007 for REGARDS, 2000 to 2002 for MESA, and 2000 to 2004 for JHS. BP was measured by trained staff using standardized methods. Antihypertensive medication use was self-reported. The primary outcome was incident CVD, defined by the first occurrence of fatal or nonfatal stroke, nonfatal myocardial infarction, fatal coronary heart disease, or heart failure. Events were adjudicated in each study. RESULTS:Over a mean follow-up of 7.7 years, 2584 participants had incident CVD events. Overall, 63.0% (95% confidence interval [CI], 54.9-71.1) of events occurred in participants with SBP/DBP <140/90 mm?Hg; 58.4% (95% CI, 47.7-69.2) and 68.1% (95% CI, 60.1-76.0) among those taking and not taking antihypertensive medication, respectively. The majority of events occurred in participants with SBP/DBP <140/90 mm?Hg among those <65 years of age (66.7%; 95% CI, 60.5-73.0) and ?65 years of age (60.3%; 95% CI, 51.0-69.5), women (61.4%; 95% CI, 49.9-72.9) and men (63.8%; 95% CI, 58.4-69.1), and for whites (68.7%; 95% CI, 66.1-71.3), blacks (59.0%; 95% CI, 49.5-68.6), Hispanics (52.7%; 95% CI, 45.1-60.4), and Chinese-Americans (58.5%; 95% CI, 45.2-71.8). Among participants taking antihypertensive medication with SBP/DBP <140/90 mm?Hg, 76.6% (95% CI, 75.8-77.5) were eligible for statin treatment, but only 33.2% (95% CI, 32.1-34.3) were taking one, and 19.5% (95% CI, 18.5-20.5) met the SPRINT (Systolic Blood Pressure Intervention Trial) eligibility criteria and may benefit from a SBP target goal of 120 mm?Hg. CONCLUSIONS:Although higher BP levels are associated with increased CVD risk, in the modern era, the majority of incident CVD events occur in US adults with SBP/DBP <140/90 mm?Hg. While absolute risk and cost-effectiveness should be considered, additional CVD risk-reduction measures for adults with SBP/DBP <140/90 mm?Hg at high risk for CVD may be warranted.

Project description:ImportanceExtremely low diastolic blood pressure has been reported to be associated with increased adverse cardiovascular events (ie, the diastolic J-shape phenomenon); however, current US guidelines recommend an intensive blood pressure target of less than 130/80 mm Hg without mentioning the lower limits of diastolic blood pressure.ObjectivesTo evaluate whether there is a diastolic J-shape phenomenon for patients with an treated systolic blood pressure of less than 130 mm Hg and to explore the safe and optimal diastolic blood pressure ranges for this patient population.Design, setting, and participantsThis cohort study analyzed outcome data of patients at high cardiovascular risk who were randomized to intensive or standard blood pressure control and achieved treated systolic blood pressure of less than 130 mm Hg in the Systolic Blood Pressure Intervention Trial (SPRINT) and Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD-BP) trial. Data were collected from October 2010 to August 2015 (SPRINT) and from September 1999 to June 2009 (ACCORD-BP). Data were analyzed from January to May 2020.ExposureTreated diastolic blood pressure, divided in intervals of less than 60, 60 to less than 70, 70 to less than 80, and 80 mm Hg and greater.Main outcomes and measuresThe primary outcome was a composite of all-cause death, nonfatal myocardial infarction, and nonfatal stroke. A composite cardiovascular outcome, including cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke, was among the key secondary outcomes.ResultsA total of 7515 patients (mean [SD] age, 65.6 [8.7] years; 4553 [60.6%] men) were included in this analysis. The nominally lowest risk was observed at a diastolic blood pressure between 70 and 80 mm Hg for the primary outcome, the composite cardiovascular outcome, nonfatal myocardial infarction, and cardiovascular death. A mean diastolic blood pressure of less than 60 mm Hg was associated with significantly increased risk of the primary outcome (hazard ratio [HR], 1.46; 95% CI, 1.13-1.90; P = .004), the composite cardiovascular outcome (HR, 1.74; 95% CI, 1.26-2.41; P = .001), nonfatal myocardial infarction (HR, 1.73; 95% CI, 1.15-2.59; P = .008), and nonfatal stroke (HR, 2.67; 95% CI, 1.26-5.63; P = .01).Conclusions and relevanceThis cohort study found that lowering diastolic blood pressure to less than 60 mm Hg was associated with increased risk of cardiovascular events in patients with high cardiovascular risk and an treated systolic blood pressure less than 130 mm Hg. The finding that a diastolic blood pressure value between 70 and 80 mm Hg was an optimum target for this patient population merits further study.

Project description:PurposeTo investigate the relationship between visualization and blood pressure during arthroscopic rotator cuff repair (ARCR) in the beach-chair position and to clarify the optimal blood pressure to maintain good visualization during surgery.MethodsOne senior surgeon evaluated intraoperative visualization at the start of arthroscopy, at acromioplasty, at the refresh of the footprint on the greater tuberosity, at marrow vent creation in the footprint on the greater tuberosity, and at rotator cuff fixation. The evaluation grades were: 5, clear; 4, mild bleeding; 3, bleeding but operable; 2, poor visualization due to bleeding; and 1, inability to continue surgery due to massive bleeding. During ARCR, an arterial line was inserted, and blood pressure was measured continuously. The relationship between visualization and blood pressure was analyzed. Receiver operating characteristic analysis was performed with evaluation grades 5 and 4 as the good visualization group and the other evaluation grades as the poor visualization group.ResultsVisualization assessment and systolic/diastolic blood pressure were associated at the start of arthroscopy (P = .0257/.0057), at acromioplasty (P = .0023/.0399), and at the refresh of the footprint (P = .0201/.0272). The average blood pressure of evaluation grade 5 cases was 91/50 mm Hg. The cut-off values, based on the area under the curve on receiver operating characteristic analysis, were as follows: 104/60 mm Hg (0.91-0.95) at acromioplasty; 116/70 (0.94-0.96) at the refresh of the footprint; 116/70 mm Hg (0.94-0.96) at the refresh of the footprint; and 106/58 mm Hg (0.73-0.70) at marrow vent creation.ConclusionsGood visualization during ARCR in the beach-chair position was significantly associated with blood pressure. An optimal blood pressure resulting in good visualization that would not cause excessive hypotension during ARCR surgery in the beach-chair position might be a systolic blood pressure of 100 mm Hg.Level of evidenceIII, prospective, nonrandomized, observational study.

Dataset Information

Diastolic blood pressure achieved at target systolic blood pressure (120-140 mm Hg) and dabigatran-related bleeding in patients with nonvalvular atrial fibrillation: A real-world study.

Publications

Diastolic blood pressure achieved at target systolic blood pressure (120-140 mm Hg) and dabigatran-related bleeding in patients with nonvalvular atrial fibrillation: A real-world study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure