Association between blood pressure levels and risk of stroke in patients with atrial fibrillation: results from a prospective registry in Xinjiang, China

Background The relationship between blood pressure (BP) levels upon hospital admission and in-hospital stroke in patients hospitalized with atrial fibrillation (AF) remains unclear and has been complicated by current guidelines with two different thresholds (≥140/90 mm Hg and ≥130/80 mm Hg) for treating hypertension. Methods We retrospectively analyzed consecutive patients hospitalized with AF at the First Affiliated Hospital of Xinjiang Medical University, China, between January 2010 and April 2025. The association between BP levels and the risk of stroke was analyzed by logistic regression model. Restricted cubic spline models were used to provide more precise estimates and to explore the shapes of the relationships of systolic BP (SBP) and diastolic BP (DBP) with stroke. Results A total of 25 638 patients hospitalized with AF were included in this study. Compared with participants with SBP/DBP <120/80 mmHg, multivariable-adjusted odds ratios (95% CIs) of stroke were 1.27 (1.16–1.39), 1.26 (1.11–1.45), and 1.76 (1.44–2.15) for those with SBP/DBP 140–159/90–99 mmHg, 160–179/100–109 mmHg, and ≥180/110 mmHg, respectively. Restricted cubic spline regression models showed linear dose-response relationships of SBP and DBP with stroke. Sensitivity and subgroup analyses further confirmed these results. Conclusions Elevated BP level was independently associated with a higher risk of stroke among patients with AF in Xinjiang, China. Recognizing and controlling elevated BP would be important to optimally reduce the risk of stroke.