CRAFT
(2026)Objective
PROBE RCT testing whether intensive home BP-guided lowering (target SBP <120 mmHg) reduces major cardiovascular events compared with standard target (<135 mmHg) in patients with atrial fibrillation and additional CV risk.
Study Summary
• Achieved group difference in SBP: 8 mmHg.
• Primary hierarchical composite (CV death, stroke, MI, HF hospitalization) win ratio: unmatched 1.02 (0.90-1.15); matched 1.02 (0.90-1.15).
• No reduction in major CV events vs standard.
• Subgroup signal: male, younger, on oral anticoagulants tended to benefit.
• Primary hierarchical composite (CV death, stroke, MI, HF hospitalization) win ratio: unmatched 1.02 (0.90-1.15); matched 1.02 (0.90-1.15).
• No reduction in major CV events vs standard.
• Subgroup signal: male, younger, on oral anticoagulants tended to benefit.
Intervention
Intensive home-SBP target <120 mmHg vs standard target <135 mmHg
Inclusion Criteria
China, Japan. Atrial fibrillation with >=1 additional CV risk factor (IS, DM, MI, CKD); home SBP 125-154 mmHg after 2-week run-in; able to upload home BP recordings. Age 69, HTN 96%, DOAC 66%, no AC 23%.
Study Design
Arms: Intensive (<120 mmHg) vs Standard (<135 mmHg)
Patients per Arm: Intensive n=838 vs Standard n=838 (total 1676)
Outcome
• Group SBP difference: 8 mmHg.
• Primary win ratio (hierarchical composite): 1.02 (0.90-1.15), NS.
• Matched win ratio: 1.02 (0.90-1.15).
• Subgroup: male/younger/on OAC tended to benefit.
• Primary win ratio (hierarchical composite): 1.02 (0.90-1.15), NS.
• Matched win ratio: 1.02 (0.90-1.15).
• Subgroup: male/younger/on OAC tended to benefit.