February 9, 2018HeartOpen Access

Ambulatory blood pressure and long-term risk for atrial fibrillation

Q: What are the key findings of this study?

Each 1 SD increase in baseline 24-hour systolic ambulatory blood pressure was associated with a 27% increased risk of incident atrial fibrillation (HR 1.27).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Incident atrial fibrillation (n=3956). Intervention: Ambulatory blood pressure (24-hour systolic) vs. Lower ambulatory blood pressure. Primary outcome: Incident atrial fibrillation (HR 1.27, 95% CI 1.07-1.51, p=0.0056).

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Key result

Higher 24-hour systolic ambulatory BP linked to ~27% greater incident AF risk per SD.

HR 1.27
95% CI 1.07-1.51
P=0.0056
n=3,956

Why the study?

Does higher ambulatory blood pressure increase the risk of incident atrial fibrillation in the general population?

Population

3,956 subjects randomly recruited from the general population in five European countries, of which 2,776…

Comparison

Higher ambulatory blood pressure vs Lower ambulatory blood pressure

Design

Cohort

Follow-up

median 14 years

Authors

VTValérie TikhonoffPreventive Cardiology LTLutgarde ThijsUniversity College Dublin NCNicholas CauwenberghsVrije Universiteit Brussel

Discussion

Member takes

Implication

Supports ambulatory SBP for AF risk stratification in general populations; leaves open whether BP lowering prevents incident AF.

Study Design

Type

Cohort (n=3,956)

Multicenter

Yes

Structured PICO

Does higher ambulatory blood pressure increase the risk of incident atrial fibrillation in the general population?

Population

3,956 adults from the general population across five European countries, free of atrial fibrillation at baseline, followed for a median of 14 years.

Exposure

Higher ambulatory blood pressure (24-hour, daytime, and night-time systolic BP, and daytime systolic BP load)

Comparator

Lower ambulatory blood pressure (e.g., lower quartile of daytime systolic BP load <3%)

Outcome

Incidence of new-onset atrial fibrillation assessed from ECGs and medical recordshard clinical

Main Result

Hazard Ratio: 1.27 (95% CI 1.07–1.51)

p-value: p=0.0056

Systolic ambulatory blood pressure is a significant predictor of incident atrial fibrillation, suggesting that ambulatory BP monitoring may help identify individuals at high risk for AF.

Limitations

Based only on European population-based cohorts and might not be representative for non-European populations
Low statistical power for sensitivity analysis stratified by age groups, particularly in participants above 65 years
Conventional BP was measured at participants' homes, which might differ from clinic measurements
Did not exclude the effect of different types of antihypertensive drugs over time
Diagnosis of AF was based mainly on medical records and ECGs during regular follow-up visits, without systematic ECG monitoring over time

Cite This Study

Tikhonoff et al. (2018) conducted a cohort in Incident atrial fibrillation (n=3,956). Ambulatory blood pressure (24-hour systolic) vs. Lower ambulatory blood pressure was evaluated on Incident atrial fibrillation (HR 1.27, 95% CI 1.07-1.51, p=0.0056). Each 1 SD increase in baseline 24-hour systolic ambulatory blood pressure was associated with a 27% increased risk of incident atrial fibrillation (HR 1.27).

synapsesocial.com/papers/6aa38ae99fb7966fc9748f93 https://doi.org/10.1136/heartjnl-2017-312488

Topics

Atrial fibrillation Persistent AF management Hypertension management Anticoagulation in AF

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Ambulatory blood pressure and long-term risk for atrial fibrillation

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Ambulatory blood pressure and long-term risk for atrial fibrillation

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider