Blood Pressure and Atrial Fibrillation: AFFIRM Analysis
Blood Pressure and Atrial Fibrillation: AFFIRM Analysis
Blood Pressure and Atrial Fibrillation. Background Hypertension is an established risk factor for new-onset atrial fibrillation (AF). However, the relationship between blood pressure and recurrent AF is less well understood.
Methods and Results A pooled analysis of patient-level data from AFFIRM and AF-CHF trials was conducted on all 2,715 patients with paroxysmal or persistent AF, 68 ± 8 years, 66% male, randomized to rhythm control and followed for 40.6 ± 16.5 months. We assessed the impact of a baseline systolic blood pressure (SBP; <120 mmHg [N = 1,008], 120–140 mmHg [N = 930], >140 mmHg [N = 777]) on recurrent AF and proportion of time spent in AF. In patients with LVEF >40% (N = 1,719), SBP was not associated with recurrent AF in multivariate regression analyses (P = 0.752). In contrast, in patients with LVEF ≤40% (N = 996), the AF recurrence rate was higher in those with an SBP >140 mmHg compared to 120–140 mmHg (hazard ratio 1.47; 95% CI [1.12–1.93], P = 0.005). The rate of recurrent AF was similar in patients with SBP <120 mmHg compared to 120–140 mmHg (hazard ratio 1.15; 95% CI [0.92–1.43], P = 0.225). Consistently, the proportion of time spent in AF was not influenced by SBP in patients with LVEF >40% (P = 0.645). However, in patients with LVEF ≤40%, the adjusted mean proportion of time spent in AF was 17.2% if SBP was <120 mmHg, 15.4% for SBP 120–140 mmHg, and 24.0% for SBP >140 mmHg (P = 0.025).
Conclusion Systolic blood pressure is an important determinant of recurrent AF and overall AF burden in patients with left ventricular dysfunction (LVEF≤40%) but not in those with preserved ventricular function.
Systemic hypertension is a well-established and highly prevalent risk factor for new-onset atrial fibrillation (AF). Experimental evidence suggests that electrical and structural remodeling changes in the hypertensive heart may predispose to AF. It remains unclear whether systemic hypertension confers a higher risk of recurrent AF in patients with a history of paroxysmal or persistent AF, and whether optimal control of blood pressure may mitigate this risk. Moreover, the relationship between systemic hypertension and AF is poorly studied in the context of heart failure, where a lower systolic blood pressure (SBP) may reflect advanced disease and increased mortality risk. We, therefore, assessed the impact of SBP on recurrent AF and overall AF burden in a large cohort of patients with paroxysmal or persistent AF, and examined the potential influential role of left ventricular function.
Abstract and Introduction
Abstract
Blood Pressure and Atrial Fibrillation. Background Hypertension is an established risk factor for new-onset atrial fibrillation (AF). However, the relationship between blood pressure and recurrent AF is less well understood.
Methods and Results A pooled analysis of patient-level data from AFFIRM and AF-CHF trials was conducted on all 2,715 patients with paroxysmal or persistent AF, 68 ± 8 years, 66% male, randomized to rhythm control and followed for 40.6 ± 16.5 months. We assessed the impact of a baseline systolic blood pressure (SBP; <120 mmHg [N = 1,008], 120–140 mmHg [N = 930], >140 mmHg [N = 777]) on recurrent AF and proportion of time spent in AF. In patients with LVEF >40% (N = 1,719), SBP was not associated with recurrent AF in multivariate regression analyses (P = 0.752). In contrast, in patients with LVEF ≤40% (N = 996), the AF recurrence rate was higher in those with an SBP >140 mmHg compared to 120–140 mmHg (hazard ratio 1.47; 95% CI [1.12–1.93], P = 0.005). The rate of recurrent AF was similar in patients with SBP <120 mmHg compared to 120–140 mmHg (hazard ratio 1.15; 95% CI [0.92–1.43], P = 0.225). Consistently, the proportion of time spent in AF was not influenced by SBP in patients with LVEF >40% (P = 0.645). However, in patients with LVEF ≤40%, the adjusted mean proportion of time spent in AF was 17.2% if SBP was <120 mmHg, 15.4% for SBP 120–140 mmHg, and 24.0% for SBP >140 mmHg (P = 0.025).
Conclusion Systolic blood pressure is an important determinant of recurrent AF and overall AF burden in patients with left ventricular dysfunction (LVEF≤40%) but not in those with preserved ventricular function.
Introduction
Systemic hypertension is a well-established and highly prevalent risk factor for new-onset atrial fibrillation (AF). Experimental evidence suggests that electrical and structural remodeling changes in the hypertensive heart may predispose to AF. It remains unclear whether systemic hypertension confers a higher risk of recurrent AF in patients with a history of paroxysmal or persistent AF, and whether optimal control of blood pressure may mitigate this risk. Moreover, the relationship between systemic hypertension and AF is poorly studied in the context of heart failure, where a lower systolic blood pressure (SBP) may reflect advanced disease and increased mortality risk. We, therefore, assessed the impact of SBP on recurrent AF and overall AF burden in a large cohort of patients with paroxysmal or persistent AF, and examined the potential influential role of left ventricular function.
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