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Published on: July 20, 2022
Higher Cumulative Blood Pressure in Midlife Predicts an Increased Risk of Atrial Fibrillation: Evidence From the
Yun-Jiu Cheng1,2, Hai Deng1, Yun Ling3
1Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University Guangzhou China.
Insights
Cumulative high blood pressure exposure in midlife significantly increases the risk of developing atrial fibrillation later in life. This finding highlights the importance of managing blood pressure over time to prevent atrial fibrillation.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Elevated blood pressure (BP) is a known risk factor for atrial fibrillation (AF).
- The long-term impact of cumulative BP exposure in midlife on incident AF remains incompletely understood.
Purpose of the Study:
- To investigate the association between cumulative blood pressure exposure in midlife and the incidence of atrial fibrillation in mid-to-late life.
Main Methods:
- Analysis of 9892 participants from the ARIC study with four BP measurements and no baseline AF.
- Cumulative BP calculated as area under the curve; incident AF identified via ECGs, hospital codes, or death certificates.
- Follow-up averaged 15.4 years, with 1550 new-onset AF cases.
Main Results:
- AF incidence increased across quartiles of cumulative systolic BP (7.9 to 16.9 per 1000 person-years).
- Highest quartile of cumulative systolic BP, pulse pressure, and mean arterial pressure showed significantly higher hazard ratios for incident AF (1.48, 1.81, 1.22 respectively).
- Cumulative systolic BP and pulse pressure modestly improved AF prediction models.
Conclusions:
- Higher cumulative exposure to systolic BP, pulse pressure, and mean arterial pressure is significantly linked to an increased risk of incident AF.
- Long-term BP management is crucial for preventing atrial fibrillation.
Background:
Elevated blood pressure (BP) is reportedly associated with an increased risk of atrial fibrillation (AF). However, the association between cumulative BP exposure in midlife and incident AF in mid-to-late life remains unclear.
Methods And Results:
Participants enrolled in the ARIC (Atherosclerosis Risk in Communities) study with 4 consecutive BP measurements and no prevalent AF at baseline were included. Cumulative BP was calculated as the area under the curve from visit 1 to visit 4. Incident AF was identified by study visit ECGs, hospital discharge codes, or death certificates. A total of 9892 participants were included (44.6% men and mean age 62.9±5.7 years at visit 4) with 1550 (15.7%) individuals who developed new-onset AF during an average follow-up of 15.4 years. The incidence rates of AF per 1000 person-years across the 4 quartiles of cumulative systolic BP were 7.9, 9.2, 12.5, and 16.9, respectively. After multivariable adjustment, the hazard ratios for incident AF among participants in the highest quartile of cumulative systolic BP, pulse pressure, and mean arterial pressure were 1.48 (95% CI, 1.27-1.72), 1.81 (95% CI, 1.53-2.13), and 1.22 (95% CI, 1.05-1.41), respectively, compared with those in the lowest quartile. The addition of cumulative systolic BP or pulse pressure slightly improved the ability to predict new-onset AF.
Conclusions:
Higher exposure to cumulative systolic BP, pulse pressure, and mean arterial pressure was significantly associated with increased risk of incident AF.
Related Concept Videos
01:28Factors affecting Blood pressure
Physiological Factors:
01:18Hypertension and Regulation of Blood Pressure
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:17Measurement of Blood Pressure
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.