Systolic blood pressure visit-to-visit variability and outcomes in Asian patients with atrial fibrillation

Area of Science:

• Cardiology
• Clinical Research
• Epidemiology

Background:

• Atrial fibrillation (AF) is a common arrhythmia associated with increased risk of stroke and mortality.
• Blood pressure variability (BPV), specifically systolic blood pressure variability (SBP-VVV), is increasingly recognized as a significant predictor of adverse cardiovascular events.
• Understanding the impact of SBP-VVV on outcomes in diverse patient populations, such as Asian individuals with AF, is crucial for optimizing management strategies.

Purpose of the Study:

• To investigate the association between systolic blood pressure variability (SBP-VVV) and clinical outcomes in Asian patients diagnosed with atrial fibrillation (AF).
• To determine if higher degrees of SBP-VVV correlate with an increased risk of mortality, ischemic stroke or systemic embolization (SSE), major bleeding, and intracranial hemorrhage (ICH).

Main Methods:

• The study analyzed data from 3172 Asian patients with AF from the COOL-AF registry, who had baseline and at least two follow-up SBP measurements.
• Systolic blood pressure variability (SBP-VVV) was quantified using the standard deviation (SD) of average SBP and patients were stratified into quartiles based on SBP SD.
• Adjusted Cox proportional hazards models were employed to assess the relationship between SBP-VVV quartiles and adverse outcomes.

Main Results:

• Patients in the highest quartile of SBP-VVV (fourth quartile) exhibited a significantly increased risk of all-cause mortality (adjusted HR 1.60) and major bleeding (aHR 1.92) compared to the lowest quartile.
• A markedly higher risk of intracranial hemorrhage (ICH) was observed in the highest SBP-VVV quartile (aHR 3.51).
• No significant association was found between SBP-VVV quartiles and the risk of ischemic stroke or systemic embolization (SSE).

Conclusions:

• Systolic blood pressure variability (SBP-VVV) is a significant independent predictor of adverse long-term outcomes, including mortality and bleeding, in Asian patients with atrial fibrillation (AF).
• Maintaining stable systolic blood pressure, rather than just achieving target levels, is critical for improving patient outcomes.
• These findings underscore the importance of monitoring and managing blood pressure variability in AF patients to mitigate risks.