Blood Pressure and Atrial Fibrillation: A Combined AF-CHF and AFFIRM Analysis.
BACKGROUND
Hypertension is an established risk factor for new-onset atrial fibrillation (AF). However, the relationship between blood pressure and recurrent AF is less well understood.


RESULTS
A pooled analysis of patient-level data from AFFIRM and AF-CHF trials was conducted on all 2,715 patients with paroxysmal or persistent AF, 68 ± 8 years, 66% male, randomized to rhythm control and followed for 40.6 ± 16.5 months. We assessed the impact of a baseline systolic blood pressure (SBP; <120 mmHg [N = 1,008], 120-140 mmHg [N = 930], >140 mmHg [N = 777]) on recurrent AF and proportion of time spent in AF. In patients with LVEF >40% (N = 1,719), SBP was not associated with recurrent AF in multivariate regression analyses (P = 0.752). In contrast, in patients with LVEF ≤40% (N = 996), the AF recurrence rate was higher in those with an SBP >140 mmHg compared to 120-140 mmHg (hazard ratio 1.47; 95% CI [1.12-1.93], P = 0.005). The rate of recurrent AF was similar in patients with SBP <120 mmHg compared to 120-140 mmHg (hazard ratio 1.15; 95% CI [0.92-1.43], P = 0.225). Consistently, the proportion of time spent in AF was not influenced by SBP in patients with LVEF >40% (P = 0.645). However, in patients with LVEF ≤40%, the adjusted mean proportion of time spent in AF was 17.2% if SBP was <120 mmHg, 15.4% for SBP 120-140 mmHg, and 24.0% for SBP >140 mmHg (P = 0.025).


CONCLUSIONS
Systolic blood pressure is an important determinant of recurrent AF and overall AF burden in patients with left ventricular dysfunction (LVEF≤40%) but not in those with preserved ventricular function.
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Maxime
M
Tremblay-Gravel
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Michel
M
White
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Denis
D
Roy
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.|The Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.
Hugues
H
Leduc
Libin Cardiovascular Institute, Calgary, Alberta, Canada.
D George
DG
Wyse
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Julia
J
Cadrin-Tourigny
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.|The Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.
Azadeh
A
Shohoudi
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Laurent
L
Macle
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Marc
M
Dubuc
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Jason
J
Andrade
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Lena
L
Rivard
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Peter G
PG
Guerra
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Bernard
B
Thibault
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Mario
M
Talajic
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.|The Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.
Paul
P
Khairy
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy; D001794:Blood Pressure; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology; D016277:Ventricular Function, Left
atrial fibrillation; blood pressure; heart failure; hypertension