Does elevated blood pressure (SBP, DBP, or extreme PP) increase the risk of incident ischemic stroke in young adults (20-39 years) with atrial fibrillation?
Elevated systolic and diastolic blood pressure, as well as extreme pulse pressure, are significant risk factors for ischemic stroke in young adults (20-39 years) with atrial fibrillation.
BACKGROUND Elevated blood pressure (BP) levels are associated with a higher risk of stroke in patients with atrial fibrillation (AF). However, limited data exist regarding the effect of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) on ischemic stroke risk in young AF patients. OBJECTIVE To evaluate the association between BP levels and incident ischemic stroke in young adults with AF. METHODS Using the Korean Health Insurance Service database, we identified patients aged 20 -39 years, newly diagnosed as AF between January 2009 and December 2016. The primary outcome was incident ischemic stroke. RESULTS A total of 15,980 patients (mean age 32.4±4.8 years, 66.9% men) were included. Mean CHA2DS2-VASc score was 0.7±0.8 and oral anticoagulation rate was 5.6%. During a median 5.2 years (IQR 3.1-7.3) of follow-up, 73 patients had incident ischemic stroke (incidence rate 0.9 per 1,000 person-years). After multivariable adjustments, SBP 140-159 mmHg and ≥160 mmHg were associated with higher risks of ischemic stroke compared to SBP <100 mmHg (HRs 8.39 95% CI 1.02-68.73 and 11.59 1.14-118.05, respectively). Compared to DBP<65 mmHg, DBP≥95mmHg was associated with higher risk of ischemic stroke, with HR 4.18 95% CI 1.26-13.87. Those with PP <30, 50-59 and ≥60 mmHg were associated with higher risks of ischemic stroke compared to patients with PP 40-49 mmHg (HRs 3.96 95% CI 1.36-11.53, 1.82 1.04-3.18 and 3.15 1.49-6.64, respectively). CONCLUSION For young patients aged 20-39 years diagnosed with AF, elevated SBP, DBP, and extreme PP are associated with increased risks of ischemic stroke.
Ahn et al. (Sun,) studied this question.