Park S, Bergmark BA, Shi M, et al. - Among 19,679 patients with atrial fibrillation and hypertension grouped based on average systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation–Thrombolysis in Myocardial Infarction 48 trial, researchers assessed the interaction between blood pressure and the efficacy and safety of direct oral anticoagulants. With stratification by average SBP and DBP, they compared a higher dose edoxaban regimen (60/30 mg) with warfarin in terms of efficacy and safety. They reported a significantly more frequent occurrence of stroke/systemic embolic event in patients with elevated average SBP or DBP levels. Across the full range of SBP and DBP, stroke/systemic embolic event was attenuated by the higher dose edoxaban regimen vs warfarin. Without change by average SBP, the risk of major bleeding events (including intracranial hemorrhage) was attenuated with the higher dose edoxaban regimen. Overall, edoxaban had consistent efficacy and safety across the full range of SBP, while the superior safety of edoxaban was most pronounced among patients with elevated DBP levels.