Combo Tx May Improve Anticoagulant Activity, Reduce Hypertensive Damage

Coagulant activity was improved with the use of both anticoagulation and antihypertensive therapies in combination.
Coagulant activity was improved with the use of both anticoagulation and antihypertensive therapies in combination.

The following article is part of conference coverage from the 2018 AHA Scientific Sessions in Chicago, Illinois. MPR's staff will be reporting breaking news associated with research conducted by leading experts in cardiology. Check back for the latest news from AHA 2018.

CHICAGO —A combination of anticoagulation and antihypertensive therapies may be more effective than individual agents alone for improving overall coagulant activity and reducing hypertensive organ damage. This research was presented at the American Heart Association 2018 Scientific Sessions, held November 10 to 12.

Investigators of this study sought to estimate the effects of combining anticoagulation and antihypertensive therapy (rivaroxaban and nifedipine). The study population included 104 patients with atrial fibrillation who received 10 or 15 mg rivaroxaban after breakfast every day for 8 weeks.

Fifty participants reported early-morning hypertension during the study period and received 20 to 40mg nifedipine administered at bedtime for an additional 8 weeks while maintaining daily rivaroxaban use.

Study outcomes, which included measures of anti-factor Xa activity, fragments 1+2, D-dimer, and urinary albumin-creatinine ratio, were assessed at baseline and at 4, 8, 12, and 16 weeks.

An optimal range for fragments 1+2 was defined as 69 to 229pmol/L, and D-dimer measures ≥1µg/mL were considered positive.

The results of the study showed that morning systolic blood pressure levels were lower at both week 12 (119.0±12.1 mmHg) and week 16 (118.5±12.1 mmHg) than at week 8 (133.4±10 mmHg) (P<.001).

The proportion of participants who achieved the optimal range of fragments 1+2 increased between baseline and week 4, from 70.8% to 86.1% (P=.033); this trend was observed through week 8.

Although positive D-dimer rates decreased from baseline to week 4 and week 8, the reduction was not considered significant. During the second 8-week period of the study, D-dimer measures were negative among all participants.

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The urinary albumin-creatinine ratio reduced significantly between baseline and week 12 (median 16.8 vs 13.7 mg/gCr, P=.031), but the observed reduction was not significant at week 4 or week 8.

The combination of anticoagulation and antihypertensive therapy may have improved anticoagulant activity and reduced evidence of hypertensive organ damage which anticoagulation therapy alone could not achieve.  

K. Kario declares multiple associations with the pharmaceutical industry. Please see reference for a full list of author's disclosures.

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Reference

Kabutoya T, Ohmori T, Fujiwara T, Kario K. The combination therapy rivaroxaban and nifedipine improved coagulant activity and hypertensive organ damage: the HARMONY study. Presented at: AHA Scientific Sessions 2018; November 10-12, 2018; Chicago, IL. Abstract Mo1139/1139.