Atrial fibrillation and ischemic stroke in patients with hypertension: A multicenter nation-wide study

Background: Limited data had been reported regarding association between non-valvular atrial fibrillation [AF] and ischemic stroke in hypertensive patients as a nation-wide study in Thailand. Objective: The primary objective of the present study was to investigate association between AF and stroke in patients with hypertension in a multicenter, nation-wide study in Thailand. Secondary objectives included 1) determine the prevalence of stroke in patients with hypertension, and 2) determining the extent of the increase in risk of ischemic stroke in patients with hypertension. Materials and Methods: A cross-sectional study was conducted in hypertensive patients who visited 831 Thailand Ministry of Public Health [MoPH] hospitals between 2011 and 2012 to evaluate the status of standard care. Inclusion criteria were hypertensive patients aged 20 years old and older who received medical care in a MoPH hospital for at least 12 months. Main outcome measurements include AF rhythm, age, gender, cardiovascular risk factors, and ischemic stroke. Results: Thirteen thousand two hundred seven patients with hypertension and available ECG data were included. AF was detected in 457 patients (3.46%). Five hundred thirty-six (4.1%) patients had stroke, with 503 (3.8%) having ischemic stroke. From multivariate logistic regression analysis, old age, male gender, AF, LDL-cholesterol less than 100 mg/dl, and high diastolic blood pressure were factors found to be independently associated with increased risk of ischemic stroke. Crude and multivariable adjusted odds ratio of AF and ischemic stroke was 2.32 (1.64 to 3.29) and 1.70 (1.09 to 2.65), respectively. Conclusion: AF is an independent risk factor associated with ischemic stroke in patients with hypertension.