title: Optimal blood pressure in patients with atrial fibrillation (from the AFFIRM Trial).
abstract: Many medications used to treat atrial fibrillation (AF) also reduce blood pressure (BP). The relation between BP and mortality is unclear in patients with AF. We performed a post hoc analysis of 3,947 participants from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management trial. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) at baseline and follow-up were categorized by 10-mm Hg increments. The end points were all-cause mortality (ACM) and secondary outcome (combination of ACM, ventricular tachycardia and/or fibrillation, pulseless electrical activity, significant bradycardia, stroke, major bleeding, myocardial infarction, and pulmonary embolism). SBP and DBP followed a "U-shaped" curve with respect to primary and secondary outcomes after multivariate analysis. A nonlinear Cox proportional hazards model showed that the incidence of ACM was lowest at 140/78 mm Hg. Subgroup analyses revealed similar U-shaped curves. There was an increased ACM observed with BP <110/60 mm Hg (hazard ratio 2.4, p <0.01, respectively, for SBP and DBP). In conclusion, in patients with AF, U-shaped relation existed between BP and ACM. These data suggest that the optimal BP target in patients with AF may be greater than the general population and that pharmacologic therapy to treat AF may be associated with ACM or adverse events if BP is reduced to <110/60 mm Hg.
authors: Detroit Medical Center, Detroit, Michigan.
authors: Apurva O
authors: AO
authors: Badheka
authors: Staten Island University Hospital, Staten Island, New York.
authors: Nileshkumar J
authors: NJ
authors: Patel
authors: Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors: Peeyush M
authors: PM
authors: Grover
authors: Staten Island University Hospital, Staten Island, New York.
authors: Neeraj
authors: N
authors: Shah
authors: Detroit Medical Center, Detroit, Michigan.
authors: Nilay
authors: N
authors: Patel
authors: Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors: Vikas
authors: V
authors: Singh
authors: University of Arkansas, Little Rock, Arkansas.
authors: Abhishek J
authors: AJ
authors: Deshmukh
authors: Drexel University School of Public Health, Philadelphia, Pennsylvania.
authors: Kathan
authors: K
authors: Mehta
authors: Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC.
authors: Ankit
authors: A
authors: Chothani
authors: Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors: Ghanshyambhai T
authors: GT
authors: Savani
authors: Detroit Medical Center, Detroit, Michigan.
authors: Shilpkumar
authors: S
authors: Arora
authors: Cedar Sinai Medical Center, Los Angeles, California.
authors: Ankit
authors: A
authors: Rathod
authors: Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors: George R
authors: GR
authors: Marzouka
authors: Staten Island University Hospital, Staten Island, New York.
authors: James
authors: J
authors: Lafferty
authors: University of Arkansas, Little Rock, Arkansas.
authors: Jawahar L
authors: JL
authors: Mehta
authors: Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: Rmitrani@med.miami.edu.
authors: Raul D
authors: RD
authors: Mitrani
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D001795:Blood Pressure Determination; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents