Systolic Blood Pressure Variability and Outcomes in Atrial Fibrillation: A Nationwide Population Study in Korea

Background:The relationship between systolic blood pressure variability (SBP-V) and clinical outcomes in patients with atrial fibrillation (AF) remains unclear.Methods: Using the Korean National Health Insurance database, we included patients with prevalent AF who received health checkups in 2013-2014, with at least three checkups in total (n = 235,091).SBP-V was defined as the standard deviation of SBP.The outcomes, including stroke, major bleeding, and all-cause death, were assessed during follow-up.Results: During the follow-up period (median, 4.9 years; interquartile range, 4.3-5.3),5,339 strokes (0.5/100 person-years [PYs]), 3,432 major bleeding incidents (0.3/100 PYs), and 16,755 all-cause mortality (1.5/100 PYs) occurred.Compared to patients with SBP 120 to < 130 mmHg at the index health checkup, those with SBP ≥ 130 mmHg had a significantly higher risk of stroke and major bleeding risk.All-cause mortality was elevated at both high (≥ 150 mmHg) and low (< 120 mmHg) SBP levels.Compared to the lowest SBP-V group, the highest SBP-V group had significantly higher risks of stroke (adjusted hazard ratio [aHR], 1.211; 95% confidence interval [CI], 1.125-1.304),major bleeding (aHR, 1.125; 95% CI, 1.025-1.234),and all cause death (aHR, 1.189; 95% CI, 1.141-1.239).No significant interactions were observed between oral anticoagulation use and SBP-V for any of the clinical outcomes.Conclusion: SBP and SBP-V were independently associated with higher risks of stroke, major bleeding, and all-cause death in patients with AF.These findings highlight the importance of not only achieving target blood pressure levels but also minimizing SBP variability through optimal hypertension management to improve outcomes in this population.