Hypertension and atrial fibrillation predict major adverse events independently. Visit-to-visit variability (VVV) in systolic blood pressure (SBP) predicts outcomes beyond SBP itself, but risk associated with SBP-VVV in atrial fibrillation remains uncertain. We evaluated relationships between SBP-VVV, quality of oral anticoagulation control, and outcomes in patients with atrial fibrillation. Data from the AFFIRM trial (atrial fibrillation follow-up investigation of rhythm management) were analyzed. SBP-VVV was defined according to SD of SBP (SBP-SD) during follow-up. SBP-VVV was categorized by quartiles (1st, <10.09; 2nd, 10.09-13.85; 3rd, 13.86-17.33; and 4th, >= 17.34 mm Hg) and as a continuous variable. Among the original cohort, 3843 (94.7%) patients were eligible. Time in therapeutic range and percentage of international normalized ratio in range were progressively lower by quartiles (both P<0.001). An inverse linear association existed between SBP-SD and time in therapeutic range/percentage of international normalized ratio in range (P<0.001). After a median (interquartile range) follow-up of 3.6 (2.7-4.6) years, stroke and major bleeding rates progressively increased by SBP-VVV quartile (both P<0.001). Patients in the 4th quartile had the highest rate of cardiovascular and all-cause death (P=0.005 and P<0.001). A Cox multivariate analysis confirmed that 3rd and 4th quartiles were associated independently with a higher risk for stroke (P=0.042 and P=0.004) and major bleeding (P=0.009 and P<0.001). Patients in 4th quartile had also a higher risk for all-cause death (P=0.048). SBP-SD as a continuous variable was associated with increased risk for all outcomes. In conclusion, SBP-VVV is inversely associated with quality of anticoagulation control and independently predicts major adverse outcomes. Management of blood pressure variability may improve outcomes in atrial fibrillation.

Systolic blood pressure visit-to-visit variability and major adverse outcomes in atrial fibrillation. The AFFIRM study (Atrial Fibrillation Follow-Up Investigation of Rhythm Management) / Proietti, Marco; Romiti, Giulio Francesco; Olshansky, Brian; Lip, Gregory Y. H.. - In: HYPERTENSION. - ISSN 0194-911X. - STAMPA. - 70:5(2017), pp. 949-958. [10.1161/HYPERTENSIONAHA.117.10106]

Systolic blood pressure visit-to-visit variability and major adverse outcomes in atrial fibrillation. The AFFIRM study (Atrial Fibrillation Follow-Up Investigation of Rhythm Management)

Proietti, Marco;Romiti, Giulio Francesco;
2017

Abstract

Hypertension and atrial fibrillation predict major adverse events independently. Visit-to-visit variability (VVV) in systolic blood pressure (SBP) predicts outcomes beyond SBP itself, but risk associated with SBP-VVV in atrial fibrillation remains uncertain. We evaluated relationships between SBP-VVV, quality of oral anticoagulation control, and outcomes in patients with atrial fibrillation. Data from the AFFIRM trial (atrial fibrillation follow-up investigation of rhythm management) were analyzed. SBP-VVV was defined according to SD of SBP (SBP-SD) during follow-up. SBP-VVV was categorized by quartiles (1st, <10.09; 2nd, 10.09-13.85; 3rd, 13.86-17.33; and 4th, >= 17.34 mm Hg) and as a continuous variable. Among the original cohort, 3843 (94.7%) patients were eligible. Time in therapeutic range and percentage of international normalized ratio in range were progressively lower by quartiles (both P<0.001). An inverse linear association existed between SBP-SD and time in therapeutic range/percentage of international normalized ratio in range (P<0.001). After a median (interquartile range) follow-up of 3.6 (2.7-4.6) years, stroke and major bleeding rates progressively increased by SBP-VVV quartile (both P<0.001). Patients in the 4th quartile had the highest rate of cardiovascular and all-cause death (P=0.005 and P<0.001). A Cox multivariate analysis confirmed that 3rd and 4th quartiles were associated independently with a higher risk for stroke (P=0.042 and P=0.004) and major bleeding (P=0.009 and P<0.001). Patients in 4th quartile had also a higher risk for all-cause death (P=0.048). SBP-SD as a continuous variable was associated with increased risk for all outcomes. In conclusion, SBP-VVV is inversely associated with quality of anticoagulation control and independently predicts major adverse outcomes. Management of blood pressure variability may improve outcomes in atrial fibrillation.
2017
anticoagulant drugs; atrial fibrillation; hypertension; major bleeding; outcomes research; stroke; aged; analysis of variance; anticoagulants; antihypertensive agents; blood pressure; comorbidity; female; follow-up studies; humans; male; observer variation; office visits; predictive value of tests; prognosis; risk factors; atrial fibrillation; blood pressure determination; cardiovascular diseases; hypertension; internal medicine
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Systolic blood pressure visit-to-visit variability and major adverse outcomes in atrial fibrillation. The AFFIRM study (Atrial Fibrillation Follow-Up Investigation of Rhythm Management) / Proietti, Marco; Romiti, Giulio Francesco; Olshansky, Brian; Lip, Gregory Y. H.. - In: HYPERTENSION. - ISSN 0194-911X. - STAMPA. - 70:5(2017), pp. 949-958. [10.1161/HYPERTENSIONAHA.117.10106]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1021523
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