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Blood Pressure and Atrial Fibrillation: A Combined AF‐CHF and AFFIRM Analysis
Author(s) -
TREMBLAYGRAVEL MAXIME,
WHITE MICHEL,
ROY DENIS,
LEDUC HUGUES,
WYSE D. GEORGE,
CADRINTOURIGNY JULIA,
SHOHOUDI AZADEH,
MACLE LAURENT,
DUBUC MARC,
ANDRADE JASON,
RIVARD LENA,
GUERRA PETER G.,
THIBAULT BERNARD,
TALAJIC MARIO,
KHAIRY PAUL
Publication year - 2015
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12652
Subject(s) - medicine , atrial fibrillation , cardiology , hazard ratio , blood pressure , ejection fraction , sinus rhythm , heart failure , confidence interval
Blood Pressure and Atrial Fibrillation 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. Methods and 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). Conclusion 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.