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Optimal blood pressure in patients with atrial fibrillation (from the AFFIRM Trial)

Apurva O Badheka1, Nileshkumar J Patel2, Peeyush M Grover3

  • 1Detroit Medical Center, Detroit, Michigan.

The American Journal of Cardiology
|July 26, 2014
PubMed

Insights

In patients with atrial fibrillation (AF), blood pressure (BP) shows a U-shaped relationship with mortality. Optimal BP may be higher than in the general population, with risks increasing below 110/60 mm Hg.

Area of Science:

  • Cardiology
  • Clinical Research

Background:

  • Many atrial fibrillation (AF) medications lower blood pressure (BP).
  • The relationship between BP and mortality in AF patients is not well understood.

Purpose of the Study:

  • To investigate the association between blood pressure and mortality in patients with atrial fibrillation.

Main Methods:

  • Post hoc analysis of 3,947 participants from the AFFIRM trial.
  • Systolic (SBP) and diastolic (DBP) blood pressures categorized in 10-mm Hg increments.
  • Multivariate analysis and nonlinear Cox proportional hazards model used.

Main Results:

  • A U-shaped relationship was observed between SBP/DBP and all-cause mortality (ACM) and secondary outcomes.
  • The lowest ACM incidence occurred at a BP of 140/78 mm Hg.
  • Increased ACM was noted with BP <110/60 mm Hg (HR 2.4 for SBP and DBP).

Conclusions:

  • A U-shaped relationship exists between BP and ACM in AF patients.
  • Optimal BP targets for AF patients may differ from the general population.
  • Aggressive BP reduction (<110/60 mm Hg) with AF pharmacologic therapy may increase mortality risk.

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