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This study examined whether systolic blood pressure (SBP) affects clinical outcomes and modifies the impact of antithrombotic therapy. Methods: In this post hoc analysis, participants were stratified based on median SBP at baseline: &gt;126\u2009mmHg (High SBP group,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091042) and \u2264126\u2009mmHg (Low SBP group,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091093). The primary efficacy endpoint was a composite of cardiovascular events and all-cause death. The primary safety endpoint was major bleeding. Results: The mean SBP was 139\u2009mmHg and 114\u2009mmHg in the High and Low SBP groups, respectively. In the propensity score-matched cohort (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091684), the Low SBP group had a significantly higher incidence of the primary efficacy endpoint (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.01\u20131.88;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.039), while the primary safety endpoint was comparable between groups. In the Low SBP group, rivaroxaban monotherapy was associated with lower risks of both the primary efficacy (HR, 0.60; 95% CI, 0.41\u20130.86;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.006) and safety endpoints (HR, 0.40; 95% CI, 0.22\u20130.74;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003) compared with combination therapy, whereas no significant differences were observed in the High SBP group. Conclusions: Lower SBP was associated with increased risk of cardiovascular events and all-cause death. Rivaroxaban monotherapy demonstrated more favorable efficacy and safety outcomes particularly patients with lower SBP.\n                  <\/jats:p>","DOI":"10.1038\/s41440-025-02449-9","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T03:13:32Z","timestamp":1767582812000},"page":"1139-1149","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic impact of systolic blood pressure and antithrombotic strategy in patients with atrial fibrillation and stable coronary artery disease: a post-hoc analysis of the AFIRE trial"],"prefix":"10.1038","volume":"49","author":[{"given":"Shinichi","family":"Yamanaka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Noda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kotaro","family":"Nochioka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takumi","family":"Higuma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Kaikita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaharu","family":"Akao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junya","family":"Ako","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuya","family":"Matoba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masato","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsumi","family":"Miyauchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuhisa","family":"Hagiwara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuo","family":"Kimura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunihiko","family":"Matsui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hisao","family":"Ogawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Yasuda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the AFIRE Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"2449_CR1","doi-asserted-by":"publisher","first-page":"439","DOI":"10.31083\/j.rcm2202049","volume":"22","author":"A Saglietto","year":"2021","unstructured":"Saglietto A, Varbella V, Ballatore A, Xhakupi H, Ferrari GM, Anselmino M. 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TN reports Grants-in-Aid for Scientific Research (22K08092) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan and personal fees from Bayer Yakuhin, Medtronic Japan, and Biotronik Japan. KN reports grants from the Japan. Agency for Medical Research and Development (AMED; 21ek0210136h0003). KK reports trust research\/joint research funds from Bayer Yakuhin, and Daiichi-Sankyo; scholarship funds from Abbott; and personal fees from Bayer Yakuhin, Daiichi-Sankyo, Novartis Pharma AG, and Otsuka Pharmaceutical Co. MA reports grants from the Japan AMED, personal fees from Bristol Myers Squibb and Nippon Boehringer Ingelheim, and grants and personal fees from Bayer Yakuhin and Daiichi-Sankyo. JA reports personal fees from Bayer Yakuhin and Sanofi and grants and personal fees from Daiichi-Sankyo. TM reports grants from the Japan Cardiovascular Research Foundation and personal fees from Nippon Boehringer Ingelheim, Daiichi-Sankyo, AstraZeneca, and Bayer Yakuhin. MN reports grants and personal fees from Bayer Yakuhin, Daiichi-Sankyo, and Sanofi and personal fees from Bristol Myers Squibb and Nippon Boehringer Ingelheim. KM reports personal fees from Amgen Astellas BioPharma, Astellas Pharma, MSD, Bayer Yakuhin, Sanofi, Takeda Pharmaceutical, Daiichi-Sankyo, Nippon Boehringer Ingelheim, and Bristol Myers Squibb. NH reports grants and personal fees from Bayer Yakuhin, grants from Nippon Boehringer Ingelheim, and personal fees from Bristol Myers Squibb. KK reports grants from the Japan Cardiovascular Research Foundation, grants and personal fees from Bayer Yakuhin, Daiichi-Sankyo, Sanofi, MSD, and AstraZeneca, and personal fees from Bristol Myers Squibb and Nippon Boehringer Ingelheim. HO reports personal fees from Abbott Medical Japan, Bayer Yakuhin, Daiichi-Sankyo, Eisai, Kowa, Takeda Pharmaceutical, and Teijin. SY reports on grants from Takeda Pharmaceutical, Abbott, and Boston Scientific and personal fees from Daiichi-Sankyo and Bristol Myers Squibb. The other authors declare no conflicts of interest for this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}