Key result
Higher systolic blood pressure visit-to-visit variability was independently associated with an increased risk of stroke (P=0.004) and major bleeding (P<0.001) in patients with atrial fibrillation.
Why the study?
Is higher visit-to-visit variability in systolic blood pressure associated with worse clinical outcomes and poorer anticoagulation control in patients with atrial fibrillation?
Cohort (n=3,843)
Is higher visit-to-visit variability in systolic blood pressure associated with worse clinical outcomes and poorer anticoagulation control in patients with atrial fibrillation?
p-value: p=<0.001
Higher visit-to-visit variability in systolic blood pressure is independently associated with poorer anticoagulation control and increased risk of stroke, major bleeding, and death in patients with atrial fibrillation.
Higher SBP-VVV was associated with poorer anticoagulation control and increased stroke, bleeding, and death in AF; leaves open whether variability-targeted interventions improve outcomes.
Hypertension and atrial fibrillation predict major adverse events independently. Visit-to-visit variability (VVV) in systolic blood pressure (SBP) predicts outcomes beyond SBP itself, but risk associated with SBP-VVV in atrial fibrillation remains uncertain. We evaluated relationships between SBP-VVV, quality of oral anticoagulation control, and outcomes in patients with atrial fibrillation. Data from the AFFIRM trial (atrial fibrillation follow-up investigation of rhythm management) were analyzed. SBP-VVV was defined according to SD of SBP (SBP-SD) during follow-up. SBP-VVV was categorized by quartiles (1st, <10.09; 2nd, 10.09–13.85; 3rd, 13.86–17.33; and 4th, ≥17.34 mm Hg) and as a continuous variable. Among the original cohort, 3843 (94.7%) patients were eligible. Time in therapeutic range and percentage of international normalized ratio in range were progressively lower by quartiles (both P <0.001). An inverse linear association existed between SBP-SD and time in therapeutic range/percentage of international normalized ratio in range ( P <0.001). After a median (interquartile range) follow-up of 3.6 (2.7–4.6) years, stroke and major bleeding rates progressively increased by SBP-VVV quartile (both P <0.001). Patients in the 4th quartile had the highest rate of cardiovascular and all-cause death ( P =0.005 and P <0.001). A Cox multivariate analysis confirmed that 3rd and 4th quartiles were associated independently with a higher risk for stroke ( P =0.042 and P =0.004) and major bleeding ( P =0.009 and P <0.001). Patients in 4th quartile had also a higher risk for all-cause death ( P =0.048). SBP-SD as a continuous variable was associated with increased risk for all outcomes. In conclusion, SBP-VVV is inversely associated with quality of anticoagulation control and independently predicts major adverse outcomes. Management of blood pressure variability may improve outcomes in atrial fibrillation. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00000556.
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Proietti et al. (2017) conducted a cohort in Atrial fibrillation (n=3,843). High systolic blood pressure visit-to-visit variability (SBP-VVV) vs. Lower systolic blood pressure visit-to-visit variability was evaluated on Stroke and major bleeding (p=<0.001). Higher systolic blood pressure visit-to-visit variability was independently associated with an increased risk of stroke (P=0.004) and major bleeding (P<0.001) in patients with atrial fibrillation.
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