An adverse blood pressure polygenic risk score was associated with increased odds of uncontrolled blood pressure compared to a favorable score in ICH survivors with AF (OR 1.19; 95% CI 1.01-1.39).
Cohort (n=446)
Does an adverse polygenic profile for blood pressure increase the risk of uncontrolled BP in intracerebral hemorrhage survivors with atrial fibrillation?
Adverse polygenic profiles for blood pressure are associated with significantly worse BP control in ICH survivors with AF, suggesting genetic profiling could inform anticoagulation decision-making.
Effect estimate: OR 1.19 (95% CI 1.01-1.39)
Absolute Event Rate: 31% vs 18%
p-value: p=0.02
Abstract Background and aims Uncontrolled blood pressure (BP) can modify the risk/benefit ratio for prescribing anticoagulants to intracerebral hemorrhage (ICH) survivors with atrial fibrillation. Adverse polygenic profiles for BP increase the risk of uncontrolled BP in ischemic stroke survivors. We thus hypothesize that adverse polygenic profiles for BP are associated with higher risk of uncontrolled BP in ICH survivors with AF. Methods We conducted a genetic study within the NIH All of Us Research Program. ICH survivors with AF were identified using validated SNOMED codes. BP polygenic risk was modeled through a previously developed polygenic risk score (PRS) incorporating 7.4 million genetic variants and categorized as favorable (20th percentile), neutral, (20-80th), or adverse (80th). Outcomes were observed BP and uncontrolled BP (140 systolic or 90 diastolic) with multi-variable regression models used to adjust for confounders. Results Among 446 ICH survivors with AF (mean age 68, 46% female), mean systolic BP increased across patients in favorable, neutral and adverse PRS groups (126, 131 and 133 mmHg), as did rates of uncontrolled BP (18%, 26%, and 31%). Multivariable regression models confirmed that adverse vs favorable PRS was associated with a 7.2 mmHg higher systolic BP (SE 3.1; p=0.02) and increased odds of uncontrolled BP (OR 1.19; 95% CI 1.01-1.39). Overall, adverse BP polygenic profiles associate with significantly worse BP control in ICH survivors with AF. Because uncontrolled BP is the most important determinant of long-term outcomes in ICH survivors, these findings support further investigation into whether polygenic profiling can inform anticoagulation decision-making in this high-risk population. Conflict of interest Andrew Silberfeld, Shufan Huo, Santiago Clochiatti-Tuozzo, Cyprien Rivier, Guido Falcone: nothing to disclose.
Silberfeld et al. (Fri,) conducted a cohort in Intracerebral hemorrhage with atrial fibrillation (n=446). Adverse polygenic risk score (>80th percentile) vs. Favorable polygenic risk score (<20th percentile) was evaluated on Uncontrolled blood pressure (>140 systolic or >90 diastolic) (OR 1.19, 95% CI 1.01-1.39, p=0.02). An adverse blood pressure polygenic risk score was associated with increased odds of uncontrolled blood pressure compared to a favorable score in ICH survivors with AF (OR 1.19; 95% CI 1.01-1.39).