What is the clinical evidence from this study?

Study design: Cohort. Population: Without prior cardiovascular disease or antihypertensive treatment (n=24901). Intervention: Supine hypertension vs. Normal blood pressure. Primary outcome: Incident atrial fibrillation (aHR 1.38, 95% CI 1.09-1.75, p=0.008).

What does this research mean for the field?

Supine hypertension is independently associated with an increased risk of incident atrial fibrillation, particularly in younger adults, and improves risk prediction beyond standard seated blood pressure measurements. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To investigate the association between supine blood pressure measurements and the incidence of atrial fibrillation.

July 11, 2026JACC AdvancesOpen Access

Supine Hypertension as a Predictor of Atrial Fibrillation

Q: What are the key findings of this study?

Supine hypertension was independently associated with a 38% increased risk of incident atrial fibrillation compared to normal blood pressure, whereas seated hypertension alone was not.

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Key result

Supine hypertension linked to ~38% higher incident AF risk, while seated hypertension shows no association.

aHR 1.38
95% CI 1.09-1.75
P=0.008
n=24,901

Why the study?

Most blood pressure assessments focus on seated measurements, but supine blood pressure may offer additional predictive value for incident AF by capturing positional or autonomic variations.

Does supine hypertension predict incident atrial fibrillation in adults without prior cardiovascular disease?

Population

24,901 UK Biobank participants without prior cardiovascular disease or antihypertensive treatment

Comparison

Normal BP vs seated-only vs supine-only vs both seated and supine hypertension

Design

Prospective cohort study

Follow-up

Median 4.5 years

Authors

KLKyung-Yeon LeeKorea University Medical Center TRTae-Min RheeNew Generation University College JCJungMin ChoiSeoul National University Hospital

Discussion

Member takes

Implication

Supine BP assessment may refine AF risk stratification beyond seated measures; leaves open whether it improves prediction or guides prevention in trials.

Key Points

To investigate the association between supine blood pressure measurements and the incidence of atrial fibrillation.
Analyzed 24,901 UK Biobank participants (mean age 63.1 ± 7.7 years; 44.0% male) without prior cardiovascular disease or antihypertensive therapy.
Categorized participants into four groups based on seated and supine hypertension status (defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg).
Evaluated incident atrial fibrillation identified via health registries over a median follow-up duration of 4.5 years (IQR: 3.6-6.4 years).
Supine systolic BP independently increased incident AF risk (aHR: 1.12 per 10 mm Hg increase; 95% CI: 1.05-1.20; P = 0.001), showing a stronger link than seated systolic BP (aHR: 1.08; 95% CI: 1.01-1.15; P = 0.024).
Participants with supine hypertension (aHR: 1.38; 95% CI: 1.09-1.75; P = 0.008) and both seated and supine hypertension (aHR: 1.35; 95% CI: 1.01-1.81; P = 0.042) had significantly higher AF risk, whereas seated hypertension alone was not independently associated.
Adding supine hypertension to seated hypertension improved risk prediction, increasing the Harrell C-index from 0.553 to 0.576 (P = 0.033) and category-free net reclassification improvement by 22.3% (95% CI: 10.9-33.7; P < 0.001).

Study Design

Type

Cohort (n=24,901)

Multicenter

Yes

Structured PICO

Does supine hypertension predict incident atrial fibrillation in adults without prior cardiovascular disease?

Population

24,901 adults (mean age 63.1, 56% female) without prior cardiovascular disease or antihypertensive treatment, followed for a median of 4.5 years.

Exposure

Supine hypertension (defined as supine systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg)

Comparator

Normal blood pressure or seated-only hypertension

Outcome

Incident atrial fibrillation (identified using ICD-10 code I48 in inpatient, outpatient, or death registry) over a median follow-up of 4.5 yearshard clinical

Main Result

Hazard Ratio: 1.38 (95% CI 1.09–1.75)

Absolute Event Rate: 3.24% vs 1.94%

p-value: p=0.008

Supine hypertension is an independent predictor of incident atrial fibrillation, particularly in younger adults, providing incremental prognostic value beyond conventional seated blood pressure measurements.

Limitations

Blood pressure was measured at a single time point
Lack of out-of-office blood pressure measurements
Atrial fibrillation ascertainment was based on ICD codes
Relatively short follow-up duration
Healthy volunteer bias in the UK Biobank cohort
Potential residual confounding by unmeasured factors
Autonomic function was not directly measured, making mechanistic interpretations speculative
The UK Biobank population is unlikely to represent individuals with overt autonomic failure syndromes

Cite This Study

Lee et al. (2026) conducted a cohort in Without prior cardiovascular disease or antihypertensive treatment (n=24,901). Supine hypertension vs. Normal blood pressure was evaluated on Incident atrial fibrillation (aHR 1.38, 95% CI 1.09-1.75, p=0.008). Supine hypertension was independently associated with a 38% increased risk of incident atrial fibrillation compared to normal blood pressure, whereas seated hypertension alone was not.

synapsesocial.com/papers/6a51e474c18d7f28ca50170c https://doi.org/10.1016/j.jacadv.2026.102960

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Implication

Supine BP assessment may refine AF risk stratification beyond seated measures; leaves open whether it improves prediction or guides prevention in trials.

Supine Hypertension as a Predictor of Atrial Fibrillation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Supine Hypertension as a Predictor of Atrial Fibrillation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider