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Ambulatory Blood Pressure Characteristics and Long-Term Risk for Atrial Fibrillation
Juha S Perkiömäki1, Santeri Nortamo1, Antti Ylitalo1
1Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Insights
Elevated nighttime systolic blood pressure independently predicts long-term atrial fibrillation (AF) risk. This finding suggests nighttime blood pressure monitoring is crucial for AF prevention strategies.
Area of Science:
- Cardiology
- Hypertension Research
- Epidemiology
Background:
- Atrial fibrillation (AF) is a growing health concern, particularly with aging.
- Current risk assessment may not fully capture AF development.
- Ambulatory blood pressure (ABP) monitoring offers insights into blood pressure variations.
Purpose of the Study:
- To investigate if nighttime systolic ABP provides additional predictive value for long-term AF risk compared to daytime measurements.
- To determine the independent contribution of nighttime systolic ABP to new-onset AF.
Main Methods:
- The Oulu Project Elucidating Risk of Atherosclerosis (OPERA) study enrolled 903 participants (40-59 years) with or without hypertension.
- Participants underwent ABP monitoring, clinical examinations, and laboratory tests.
- Long-term follow-up averaged 16.4 years to ascertain new-onset AF events.
Main Results:
- 91 participants (10%) developed new-onset AF requiring hospitalization.
- Nighttime mean systolic blood pressure showed the strongest univariable association with AF occurrence.
- After multivariable adjustment for clinical factors, nighttime systolic ABP remained a significant independent predictor of AF (HR=1.07 per 5 mmHg increase, P=0.038).
Conclusions:
- Nighttime systolic blood pressure is a significant independent predictor of long-term risk for new-onset AF.
- These findings highlight the importance of considering nighttime blood pressure in AF risk stratification and prevention.
- Integrating nighttime ABP into treatment strategies may help mitigate the increasing burden of AF.
Background:
We hypothesized that elevated nighttime systolic ambulatory blood pressure (ABP) yields additional information compared with daytime systolic ABP for the long-term risk of atrial fibrillation (AF) and perhaps should be taken into account in treatment strategies for preventing the increasing burden of AF during aging.
Methods:
A total of 903 subjects with or without hypertension aged 40 to 59 years, who were recruited to the Oulu Project Elucidating Risk of Atherosclerosis (OPERA) study, underwent ABP monitoring, thorough clinical examinations and laboratory tests.
Results:
After an average of 16.4 ± 3.6 years of follow-up, 91 (10%) of the study subjects had experienced a new-onset AF requiring a hospital emergency room or hospital visit. Of the components of baseline ABP, the nighttime mean systolic blood pressure had the strongest univariable association with the occurrence of AF (120.8 ± 15.9 vs. 116.4 ± 14.1 mm Hg, P = 0.006, in subjects with vs. without the occurrence AF). When the univariable predictors of AF, such as age, sex, body mass index, height, smoking history, alanine aminotransferase, uric acid, and fasting plasma glucose, were entered in the multivariable Cox hazards model, age (P < 0.001), and body mass index (P = 0.014) retained their significant predictive power. After adjustments in this clinical hazards model, the nighttime mean systolic blood pressure still predicted the occurrence of AF (hazards ratio = 1.07 per every 5 mm Hg increase, 95% confidence intervals = 1.004-1.15, P = 0.038).
Conclusion:
Of the baseline ABP characteristics, the nighttime systolic blood pressure is a significant independent contributor to the long-term risk of new-onset AF requiring a hospital visit.
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