Usual blood pressure, atrial fibrillation and vascular risk: evidence from 4.3 million adults

Abstract

Background: Although elevated blood pressure is associated with an increased risk of atrial fibrillation (AF), it is unclear if this association varies by individual characteristics. Furthermore, the associations between AF and a range of different vascular events are yet to be reliably quantified. Methods: Using linked electronic health records, we examined the time to first diagnosis of AF and time to first diagnosis of nine vascular events in a cohort of 4.3 million adults, aged 30 to 90 years, in the UK. Results: A 20-mmHg higher usual systolic blood pressure was associated with a higher risk of AF [hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.19, 1.22]. The strength of the association declined with increasing age, from an HR of 1.91 (CI 1.75, 2.09) at age 30-40 to an HR of 1.01 (CI 0.97, 1.04) at age 80-90 years. AF without antithrombotic use at baseline was associated with a greater risk of any vascular event than AF with antithrombotic usage (P interaction < 0.0001). AF without baseline antithrombotic usage was associated with an increased risk of ischaemic heart disease (HR 2.52, CI 2.23, 2.84), heart failure (HR 3.80, CI 3.50, 4.12), ischaemic stroke (HR 2.72, CI 2.19, 3.38), unspecified stroke (HR 2.59, CI 2.25, 2.99), haemorrhagic stroke, chronic kidney disease, peripheral arterial disease and vascular dementia, but not aortic aneurysm. Conclusions: The association between elevated blood pressure and AF attenuates with increasing age. AF without antithrombotic usage is associated with an increased risk of eight vascular events.

BEHRT: Transformer for Electronic Health Records

“…CPRD is broadly representative of the population by age, sex, and ethnicity. It has been extensively validated and is considered as the most comprehensive longitudinal primary care database [20], with several large-scale epidemiological reports [19,21,22] adding to its credibility.…”

Risk Factor Management in Atrial Fibrillation

“…104 On the other hand, patients with AF have a higher risk of chronic kidney disease, as demonstrated by a large population-based study from the UK and a meta-analysis including approximately 10 million patients from 104 studies. 105,106 Reduced renal function is associated with increased risk of adverse cardiovascular outcomes, such as stroke and HF. 107,108 It has also been associated with increased risk of stroke and systemic embolism in patients with non-valvular AF.…”

Patients with coronary heart disease and very low blood pressure are at increased risk of cardiovascular events

“…Investigators used adjusted Cox proportional hazards models to assess associations between BP and risk of a range of CVD outcomes over 5 years. In contrast with most previous studies that have used baseline BP as their exposure variable or have corrected these for regression dilution bias,3 they defined their primary exposure variable as the arithmetic mean of all BP values from baseline to the last available measurement before an event (average BP). Presumably, because average BP might increase the risk of reverse causality, they also report associations for baseline BP as an alternative exposure variable.…”