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Published on: February 26, 2013
Blood Pressure and Atrial Fibrillation: A Combined AF-CHF and AFFIRM Analysis
Maxime Tremblay-Gravel1, Michel White1, Denis Roy1
1Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Insights
High systolic blood pressure increases recurrent atrial fibrillation (AF) risk in patients with reduced left ventricular ejection fraction (LVEF ≤40%). Blood pressure control is crucial for managing AF burden in these individuals.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Hypertension is a known risk factor for developing new-onset atrial fibrillation (AF).
- The impact of blood pressure on recurrent AF episodes is not fully understood.
- Left ventricular ejection fraction (LVEF) may influence the relationship between blood pressure and AF recurrence.
Purpose of the Study:
- To investigate the association between baseline systolic blood pressure (SBP) and the recurrence of atrial fibrillation (AF).
- To determine if SBP affects the proportion of time patients spend in AF.
- To explore these relationships in patients stratified by LVEF.
Main Methods:
- Pooled analysis of 2,715 patients from the AFFIRM and AF-CHF trials with paroxysmal or persistent AF.
- Patients were categorized by baseline SBP: <120 mmHg, 120-140 mmHg, and >140 mmHg.
- Multivariate regression analyses were used to assess the impact of SBP on AF recurrence and time in AF, stratified by LVEF.
Main Results:
- In patients with preserved LVEF (>40%), SBP was not significantly associated with AF recurrence or time in AF.
- In patients with reduced LVEF (≤40%), SBP >140 mmHg was linked to a higher rate of AF recurrence (HR 1.47; P=0.005).
- For patients with reduced LVEF, higher SBP (>140 mmHg) also correlated with a greater proportion of time spent in AF (P=0.025).
Conclusions:
- Systolic blood pressure significantly influences recurrent AF and AF burden in patients with left ventricular dysfunction (LVEF ≤40%).
- In patients with preserved ventricular function, SBP does not appear to be a determinant of recurrent AF.
- These findings highlight the importance of blood pressure management in patients with heart failure and AF.
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.
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