ABSTRACT NUMBER: ESOC2026LT22 LT22 - THE CARDIOVASCULAR RISK REDUCTION IN PATIENTS WITH ATRIAL FIBRILLATION TRIAL (CRAFT): EFFECTS OF INTENSIVE BLOOD PRESSURE CONTROL IN AF PATIENTS

Abstract Background and aims CRAFT was an investigator-conducted, international, multicenter, open-label, blinded outcome assessed, randomized controlled trial to determine the effectiveness of intensive long-term blood pressure (BP) control on the prevention of major adverse cardiovascular events in patients with AF (ClinicalTrials.gov NCT04347330). Methods Eligible adults were ‘high-risk’ AF, with another CV risk factor (age ≥65 years, history of ischemic stroke/TIA, systemic embolism, diabetes, or coronary, peripheral artery, or chronic kidney disease) and a resting office SBP 140-179mmHg (or home 125-154mmHg) on ≤3 antihypertensive drugs. Participants who successfully completed a 2-week run-in phase were randomized to intensive (home SBP <120mmHg) or standard BP (home SBP <135mmHg) BP control according to standardized protocols. The primary outcome was a hierarchical time/event composite of centrally adjudicated CV death, stroke, myocardial infarction, and heart failure hospitalization, compared using the win-ratio approach, where 1600 patients with a mean 3-years follow-up was estimated to provide 80% power to detect an effect size of 1.5. Results Of 2109 patients who entered the run-in phase, 1676 (mean age 69 yr; male 60%) were randomized at 145 sites in China and 12 sites in Japan during 2020-2024. During a mean follow-up of 2.7 person-years, the mean between-group DSBP was 8mmHg (121mmHg intensive vs. 129mmHg control). The main results are to be presented. Conclusions CRAFT will provide evidence as to whether more-intensive long-term BP control, as compared to contemporaneous recommended BP management (SBP <130mmHg) in AF, provides greater benefits for secondary prevention in this high-risk patient group. Conflict of interest