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

  • Yayuan Zheng
  • Yuyu Liu
  • Jihong Bi
  • Weiguang Lai
  • Chunyu Lin
  • Jianhong ZhuEmail author
  • Weimin Yao
  • Qiusheng ChenEmail author
Original Research Article



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).


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.


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).


Our findings suggest that NOACs can be recommended for the prevention of stroke or systemic embolism in patients with AF and hypertension.



We acknowledge Dr. Robert P. Giugliano (Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA) for providing additional data and substantial support.

Compliance with Ethical Standards


No external funding was used in the preparation of this manuscript.

Conflict of interest

Yayuan Zheng, Yuyu Liu, Jihong Bi, Weiguang Lai, Chunyu Lin, Jianhong Zhu, Weimin Yao and Qiusheng Chen declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This article does not contain any studies with human participants or animals performed by any of the authors and no informed consent was needed.

Supplementary material

40256_2019_342_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 15 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Laboratory of Physiological SciencesGuangdong Medical UniversityZhanjiangPeople’s Republic of China
  2. 2.Department of PharmacyGuangdong Medical UniversityZhanjiangPeople’s Republic of China
  3. 3.Department of PharmacyJin Xiang People’s HospitalDongyingPeople’s Republic of China
  4. 4.Department of Respiratory MedicineThe Affiliated Hospital of Guangdong Medical UniversityZhanjiangPeople’s Republic of China
  5. 5.Department of Pharmacy, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouPeople’s Republic of China

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