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To the Editor.—In the study by the SPAF III Writing Committee for the Stroke Prevention in Atrial Fibrillation Investigators,¹ the selection of "systolic blood pressure greater than 160 mm Hg" as 1 of the 4 prespecified thromboembolic risk factors while enrolling patients with hypertension requiring drug treatment is confusing. In general, arterial blood pressure (BP) follows a circadian rhythm.² In addition, the monitoring of BP was intermittent in the study,¹ and so episodes of systolic hypertension (as defined by the authors) would be missed.

Second, information on ethnic groups was not given.¹ Some ethnic groups may have a different risk of thromboembolism or major hemorrhage compared with other ethnic groups.

Third, compliance with aspirin therapy was monitored in the study, and 86% of participants regularly took 80% or more of prescibed aspirin.¹ Although the study was not designed to examine the benefit and risk of patients with nonvalvular atrial . . . [Full Text of this Article]

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Selecting Patients With Atrial Fibrillation for Anticoagulation: Stroke Risk Stratification in Patients Taking Aspirin
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