Key result
Reverse dipping blood pressure pattern linked to ~5.2-fold higher risk of new-onset AF in hypertension.
Why the study?
Hypertension is associated with the development of AF, but the relationship between diurnal changes in blood pressure and AF has not been sufficiently explored.
Does a reverse dipping pattern increase the risk of new-onset atrial fibrillation in patients with hypertension?
Cohort (n=412)
No
Does a reverse dipping pattern increase the risk of new-onset atrial fibrillation in patients with hypertension?
Ambulatory blood pressure monitoring, particularly the identification of nocturnal reverse dipping patterns, provides superior prognostic value over office blood pressure measurements for predicting incident atrial fibrillation in hypertensive patients.
Hypertension is associated with the development of atrial fibrillation (AF). Evidence has shown that reverse dipping pattern, an abnormal increase of night-time blood pressure (BP) comparing to daytime BP, is associated with cardiovascular events. However, the relationship between diurnal changes in BP and AF has not been sufficiently explored. This paper aims to cross-sectionally explore the relationship between AF and ambulatory BP parameters, especially reverse dippers to the others, and further longitudinally analyze how BP patterns are associated to the risk of developing new-onset AF. Between February 2012 and March 2021, five out of 412 patients were identified of AF at baseline; four were reverse dippers (3.7%) and one was from the others (.3%). Cross-sectionally, the multivariate logistic regression analysis showed that reverse dippers were significantly more likely to have AF (odds ratio: 12.39, p = .030). After excluding patients with baseline AF, during the mean follow-up of 4.6 ± 3.0 years, seven patients developed AF. Longitudinally, the multivariate Cox regression analysis revealed that 24-h systolic BP (hazard ratio per 10 mmHg: 2.12, p = .015), night-time systolic BP (hazard ratio per 10 mmHg: 2.27, p = .002), and presentation of reverse dipping (hazard ratio: 5.25, p = .042) were independently associated with new-onset AF. None of the office BP measurements were associated with new-onset AF. While ambulatory BP measurements were better predictors for the incidence of AF, careful management is necessary for reverse dippers as they are at high risk of developing AF.
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Huang et al. (2022) conducted a cohort in Hypertension (n=412). Reverse dipping pattern vs. Other diurnal blood pressure patterns was evaluated on New-onset atrial fibrillation (HR 5.25, 95% CI 1.06-25.98, p=.042). A reverse dipping pattern of ambulatory blood pressure was independently associated with a higher risk of developing new-onset atrial fibrillation (HR 5.25) in patients with hypertension.
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