Novel Oral Anticoagulants for the Prevention of Stroke in Patients with Atrial Fibrillation and Hypertension: A Meta-Analysis

source extracted confidence: high 2026-04-09
#administration-oral #anticoagulants #atrial-fibrillation #humans #hypertension

Novel Oral Anticoagulants for the Prevention of Stroke in Patients with Atrial Fibrillation and Hypertension: A Meta-Analysis

Zheng et al., 2019 | Am J Cardiovasc Drugs | Meta Analysis

Citation

Zheng Yayuan, Liu Yuyu, ... Chen Qiusheng. Novel Oral Anticoagulants for the Prevention of Stroke in Patients with Atrial Fibrillation and Hypertension: A Meta-Analysis. Am J Cardiovasc Drugs. 2019-Oct;19(5):477-485. doi:10.1007/s40256-019-00342-8

Abstract

INTRODUCTION: Hypertension is associated with increased risk of stroke and bleeding in patients with atrial fibrillation (AF). In the present study, we aimed to investigate the influence of hypertension status in patients with AF receiving treatment with non-vitamin K antagonist oral anticoagulants (NOACs). METHODS: PubMed, Embase, and Cochrane Library were searched from the inception of each database to November 2017. Randomized controlled trials (RCTs) that evaluated NOACs versus warfarin in patients with AF and hypertension were identified. A meta-analysis was performed using random- or fixed-effects models according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Five trials (72,967 patients, including 51,378 patients with hypertension) were enrolled. NOACs significantly reduced the risk of stroke and systemic embolism (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.81-0.94, n = 51,378 patients), hemorrhagic stroke (HR 0.55, 95% CI 0.41-0.74, n = 28,818 patients), death from any cause (HR 0.91, 95% CI 0.85-0.97, n = 43,101 patients), major bleeding (HR 0.78, 95% CI 0.74-0.83, n = 51,378 patients) and intracranial bleeding (HR 0.50, 95% CI 0.38-0.67, n = 27,185 patients). The benefits of NOACs in comparison with warfarin were consistent in AF patients with or without hypertension (Pinteraction for all outcomes > 0.05). CONCLUSIONS: Our findings suggest that NOACs can be recommended for the prevention of stroke or systemic embolism in patients with AF and hypertension.

Key Findings

Five trials (72,967 patients, including 51,378 patients with hypertension) were enrolled. NOACs significantly reduced the risk of stroke and systemic embolism (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.81-0.94, n = 51,378 patients), hemorrhagic stroke (HR 0.55, 95% CI 0.41-0.74, n = 28,818 patients), death from any cause (HR 0.91, 95% CI 0.85-0.97, n = 43,101 patients), major bleeding (HR 0.78, 95% CI 0.74-0.83, n = 51,378 patients) and intracranial bleeding (HR 0.50, 95% CI 0.38-0.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population atrial fibrillation
Sample Size 51378
Age Range See abstract
Condition hypertension

MeSH Terms

  • Administration, Oral
  • Anticoagulants
  • Atrial Fibrillation
  • Humans
  • Hypertension
  • Stroke

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: vitamin-k

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09