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September 2023
Need for improved blood pressure control in patients with atrial fibrillation
By Melanie Hinze
Blood pressure (BP) control in patients with atrial fibrillation (AF), particularly if those patients are women or aged over 75 years, should be a focus for GPs, an Australian expert has told Medicine Today.
Professor Alta Schutte, Professor and Principal Theme Lead of Cardiac, Vascular and Metabolic Medicine in the Faculty of Medicine and Health at UNSW Sydney, and Professorial Fellow at the George Institute for Global Health, Sydney, said raised BP is very common among Australian adults, with one in three having hypertension and half of those people not being aware of it.
‘High BP is also the most significant risk factor for AF – where an estimated 70% of people with AF also have hypertension,’ she said.
‘The double-whammy, however, is that both high BP and AF are the strongest triggers for a person to have a stroke.’
The authors of a cross-sectional study, recently published in Heart, assessed BP control in 34,815 patients with AF and hypertension (mean age, 76.9 years; 46.2% female). They also looked at factors influencing BP control and the likelihood of receiving guideline-recommended treatment across Australian general practices.
They found that only 62.0% of patients had controlled BP, defined as a BP of less than 140/90 mmHg.
There were more male patients in the controlled BP group (56.4%) than female patients. Patients in the controlled BP group had a higher mean number of GP visits than those in the uncontrolled BP group (33.3±22.2 vs 29.8± 0.4, respectively). There was also greater continuity of care – that is, visits with the same clinician – in the controlled BP group (0.5±0.2) than in the uncontrolled BP group (0.4±02).
Women and adults aged 75 years or older were less likely to have controlled BP (adjusted odds ratio, 0.72 and 0.28, respectively).
Professor Schutte told Medicine Today that substantially improving control of raised BP was a key focus of the recently established National Hypertension Taskforce. Professor Schutte, who is Co-Chair of the Taskforce, highlighted that 68% of Australian adults with high BP do not have their BP under control, with or without medication.
‘With this recent paper, Trivedi and coauthors demonstrate that uncontrolled BP is more common among women and older adults with AF,’ she said.
‘This work should encourage GPs to focus even stronger on these patient groups in ensuring better BP control through intensifying BP lowering medication – ideally by adding a second or third drug, shown to be more effective than doubling the dose of monotherapy,’ Professor Shutte said.