Home blood pressure variability and risk of cardiovascular outcomes in elderly patients with non-valvular atrial fibrillation from the ANAFIE registry

Atrial fibrillation (AF) is frequently accompanied by hypertension; however, the relationship between mid-term blood pressure variability (BPV) assessed using home blood pressure (BP) measurements and prognosis in patients with AF remains unclear. We examined the association between home BPV and cardiovascular outcomes in elderly patients with non-valvular AF using data from the ANAFIE (All Nippon AF In the Elderly) Registry. This post hoc analysis of a prospective registry included 4885 patients aged ≥75 years who performed standardized home BP measurements in the morning and evening (two measurements at each time point) over seven consecutive days. Mid-term BPV was quantified using the coefficient of variation of systolic home BP and categorized into quartiles. The primary endpoint was a net cardiovascular outcome, defined as a composite of stroke, systemic embolism, and major bleeding. Associations were assessed using multivariable Cox proportional hazards models adjusted for mean BP and established risk factors. Over a median follow-up of two years, the net cardiovascular outcome occurred in 171 patients. Compared with the lowest BPV quartile, patients in the highest quartile had a significantly higher risk of the net cardiovascular outcome (HR 2.03, 95% CI 1.21–3.40). Higher risks were also observed for stroke/systemic embolism, intracranial hemorrhage, and bleeding. Findings were consistent when BPV was assessed using the standard deviation and across subgroups. In conclusion, greater mid-term home BPV was independently associated with increased cardiovascular risk beyond average BP in elderly patients with non-valvular AF.