What question did this study set out to answer?

To examine whether intensive blood pressure lowering targeting systolic blood pressure <120 mm Hg reduces the risk of incident atrial fibrillation compared with standard lowering targeting <140 mm Hg.

May 4, 2020HypertensionOpen Access

Effect of Intensive Blood Pressure Lowering on the Risk of Atrial Fibrillation

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Why the study?

It remained uncertain whether intensive blood pressure control lowers the risk of atrial fibrillation in patients with hypertension.

Does intensive blood pressure lowering reduce the risk of incident atrial fibrillation in patients with hypertension at high risk of cardiovascular disease?

Key Points

To examine whether intensive blood pressure lowering targeting systolic blood pressure <120 mm Hg reduces the risk of incident atrial fibrillation compared with standard lowering targeting <140 mm Hg.
Analysis of data from the SPRINT randomized trial (NCT01206062) including 8,022 hypertensive participants at increased cardiovascular risk free of atrial fibrillation at baseline.
Participants were randomized to an intensive blood pressure-lowering arm (target systolic blood pressure <120 mm Hg; n=4,003) or a standard arm (target <140 mm Hg; n=4,019).
Incident atrial fibrillation was detected from standard 12-lead electrocardiograms recorded at biannual examinations and an exit visit over up to 5.2 years of follow-up.
Across 28,322 person-years, incident atrial fibrillation occurred in 88 participants in the intensive arm versus 118 in the standard arm (hazard ratio, 0.74 [95% CI, 0.56–0.98]; P=0.037).
The 26% lower risk associated with intensive blood pressure lowering remained consistent across prespecified subgroups based on age, sex, race, baseline systolic blood pressure, prior cardiovascular disease, and chronic kidney disease.

Structured PICO

Does intensive blood pressure lowering reduce the risk of incident atrial fibrillation in patients with hypertension at high risk of cardiovascular disease?

Population

8022 participants with hypertension at increased risk of cardiovascular disease, free of atrial fibrillation at the time of enrollment, and with available baseline and follow-up electrocardiographic data.

Intervention

Intensive blood pressure lowering (target systolic BP <120 mm Hg)

Comparator

Standard blood pressure lowering (target systolic BP <140 mm Hg)

Outcome

Incident atrial fibrillation ascertained from standard 12-lead electrocardiograms recorded at biannual study examinations and an exit visithard clinical

Intensive blood pressure lowering to a target systolic BP <120 mm Hg significantly reduces the risk of incident atrial fibrillation in high-risk hypertensive patients.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Should not yet change practice for AF prevention; leaves open a potential added benefit of intensive SBP targeting.

Cite This Study

Soliman et al. (2020) studied this question.

synapsesocial.com/papers/6a8052fb377c56ad3031dd5e https://doi.org/10.1161/hypertensionaha.120.14766

Topics

Hypertension management Atrial fibrillation Persistent AF management Anticoagulation in AF

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Effect of Intensive Blood Pressure Lowering on the Risk of Atrial Fibrillation

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Effect of Intensive Blood Pressure Lowering on the Risk of Atrial Fibrillation

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider