Key result
Intensive blood pressure control did not diminish the incidence of new-onset atrial fibrillation compared with standard treatment (4.11 vs 4.95 per 1000-person years; P=0.14).
Why the study?
The impact of intensive blood pressure control on new-onset AF incidence and the prognostic implications of preexisting and new-onset AF were evaluated.
Does intensive blood pressure control reduce the incidence of new-onset atrial fibrillation/flutter in older, high-risk, nondiabetic patients with hypertension?
RCT (n=9,327)
Does intensive blood pressure control reduce the incidence of new-onset atrial fibrillation/flutter in older, high-risk, nondiabetic patients with hypertension?
Intensive blood pressure control does not reduce the incidence of new-onset atrial fibrillation in high-risk hypertensive patients, and both preexisting and new-onset AF remain associated with increased cardiovascular risk despite intensive BP control.
We evaluated the impact of intensive blood pressure control on the incidence of new-onset atrial fibrillation/flutter (AF) and the prognostic implications of preexisting and new-onset AF in SPRINT (Systolic Blood Pressure Intervention Trial) participants. New-onset AF was defined as occurrence of AF in 12-lead electrocardiograms after randomization in participants free of AF at baseline. Poisson regression modeling was used to calculate incident rates of new-onset AF. Multivariable-adjusted Cox proportional hazard models were used to evaluate the risk of adverse cardiovascular events (composite of myocardial infarction, non–myocardial infarction acute coronary syndrome, stroke, heart failure, or cardiovascular death). In 9327 participants, 8.45% had preexisting AF, and 1.65% had new-onset AF. The incidence of new-onset AF was 4.53 per 1000-person years, with similar rates in the standard and intensive treatment arms (4.95 versus 4.11 per 1000-person years; adjusted P =0.14). Participants with preexisting AF (adjusted hazard ratio, 1.83 [95% CI, 1.46–2.31]; P <0.001) and new-onset AF (adjusted hazard ratio, 2.45 [95% CI, 1.58–3.80]; P <0.001) had a greater risk for development of adverse cardiovascular events compared with those with no AF. Participants with preexisting AF who achieved blood pressure <120/80 mm Hg at 3 months continued have a poor prognosis (adjusted hazard ratio, 1.88 [95% CI, 1.32–2.70]; P =0.001) compared with those with no AF. Intensive blood pressure control does not diminish the incidence of new-onset AF in an older, high-risk, nondiabetic population. Both preexisting and new-onset AF have adverse prognostic implications. In participants with preexisting AF, residual cardiovascular risk is evident even with on-treatment blood pressure <120/80 mm Hg. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01206062.
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Parcha et al. (2020) conducted an RCT in Hypertension (n=9,327). Intensive blood pressure control vs. Standard treatment was evaluated on Incidence of new-onset atrial fibrillation/flutter (AF) (p=0.14). Intensive blood pressure control did not diminish the incidence of new-onset atrial fibrillation compared with standard treatment (4.11 vs 4.95 per 1000-person years; P=0.14).
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