Impact of Blood Pressure Visit‐to‐Visit Variability on Adverse Events in Patients With Nonvalvular Atrial Fibrillation: Subanalysis of the J‐RHYTHM Registry

Abstract

Background Blood pressure (BP) variability has reportedly been a risk factor for various clinical events. To clarify the influence of BP visit‐to‐visit variability on adverse events in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J‐RHYTHM Registry was performed. Methods and Results Of 7406 outpatients with nonvalvular atrial fibrillation from 158 institutions, 7226 (age, 69.7±9.9 years; men, 70.7%), in whom BP was measured 4 times or more (14.6±5.0 times) during the 2‐year follow‐up period or until occurrence of an event, constituted the study group. SD and coefficient of variation of BP values were calculated as BP variability. Thromboembolism, major hemorrhage, and all‐cause death occurred in 110 (1.5%), 121 (1.7%), and 168 (2.3%) patients, respectively. When patients were divided into quartiles of systolic BP‐SD (<8.20, 8.20–10.49, 10.50–13.19, and ≥13.20 mm Hg), hazard ratios (HRs) for all adverse events were significantly high in the highest quartile compared with the lowest quartile (HR, 2.00, 95% CI, 1.15–3.49, P =0.015 for thromboembolism; HR, 2.60, 95% CI, 1.36–4.97, P =0.004 for major hemorrhage; and HR, 1.85, 95% CI, 1.11–3.07, P =0.018 for all‐cause death) after adjusting for components of the CHA 2 DS 2 ‐VASc score, warfarin and antiplatelet use, atrial fibrillation type, BP measurement times, and others. These findings were consistent when BP‐coefficient of variation was used instead of BP‐SD. Conclusions Systolic BP visit‐to‐visit variability was significantly associated with all adverse events in patients with nonvalvular atrial fibrillation. Further studies are needed to clarify the causality between BP variability and adverse outcomes in patients with nonvalvular atrial fibrillation. Registration URL: https://www.umin.ac.jp/ctr/ ; Unique Identifier: UMIN000001569.

Impact of heart rate on adverse events in patients with non-valvular atrial fibrillation: Subanalysis of the J-RHYTHM Registry

“…The risk of baseline HR or HR-end for adverse events in each quartile or group was expressed as hazard ratios or odds ratios (ORs) and 95% confidence intervals (CIs) versus the second quartile. Explanatory variables for multivariable analysis were adopted from well-known risk factors used in our previous subanalyses for hypertension and BP [9] , [10] . These included components of the CHA 2 DS 2 -VASc score (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, history of stroke or TIA, vascular disease [coronary artery disease], age 65–74 years, female sex) [11] , warfarin and antiplatelet use, AF type, and systolic BP-end (BP at the time closest to an event or at the last visit of follow-up) (Model 1).…”

Frequency of Cardiac Arrhythmias in Hypertensive Patients

“…Other proposed mechanisms, such as demand supply mismatch particularly during stress exercises, disrupted the coronary arteries flow and consequently myocardial ischemia develops which leads to the development of arrhythmias. 23,24 The study showed direct linkage of age and gender on the prevalence and occurrence of cardiac arrhythmias. Males were more prone towards developing cardiac arrhythmias in comparison with the females of age group (<60 years) but there was no such relation after 70 years.…”

Impact of baseline blood pressure on adverse outcomes in Japanese patients with non-valvular atrial fibrillation: the J-RISK AF

“…Finally, only baseline BP values were available for the J-RISK AF. The impact of BP values at the time closest to an event, visit-to-visit BP variability, and BP consistency during the follow-up period was evaluated only in the J-RHYTHM Registry, 16 , 17 , 38 in which visit-to-visit BP values were collected.…”

“… 16 Furthermore, systolic BP visit-to-visit variability evaluated by standard deviation (SD) was also significantly associated with the incidence of thrombo-embolism, major haemorrhage, and all-cause death independent of BP-end. 17 In contrast, in the Fushimi AF Registry, a baseline systolic BP ≥150 mmHg was associated with a higher incidence of stroke/systemic embolism, haemorrhagic stroke, and major bleeding. 18 …”