Systolic BP variability predicts incident Atrial Fibrillation in middle aged & elderly

A new study found that increased visit-to-visit variability of systolic blood pressure strongly predicts incident atrial fibrillation in the middle-aged and older population and evaluating this systolic blood pressure variability helps to identify individuals at a greater risk of atrial fibrillation. The study was published in the Journal of Hypertension.  

Atrial fibrillation is the most common arrhythmia which can cause stroke, heart failure, and mortality. With increasing age, the risk of atrial fibrillation increases, and it also causes a major socioeconomic burden. Hence, researchers conducted a prospective cohort study to establish the relationship between visit-to-visit variability of SBP and incident atrial fibrillation in middle-aged and older populations. Visit-to-visit variability of SBP was defined as the average real variability (ARV) of three values of SBP from the examinations of 2006, 2008, and 2010. 

26,999 participants aged 50 years or older were enrolled in the study and they were categorized into four groups according to the quartiles of ARV. Incident atrial fibrillation cases were identified via ECG during biennial resurveys and reviewing medical insurance records and discharge registers. Cox regression models were used to evaluate the hazard ratios and 95% confidence intervals (CI) for incident atrial fibrillation. 

Results:

• In an average follow-up of 9.24 years, a total of 420 atrial fibrillation cases were identified.
• The incidence of atrial fibrillation from the lowest to the highest quartiles of SBP variability were 1.23, 1.53, 1.81, and 2.19 per 1000 person-years, respectively.
• A graded association was found between SBP variability and risk of atrial fibrillation after adjusting for potential confounders like mean blood pressure. 
• Participants in the third quartile and the highest quartile were associated with 35 and 53% higher risk of developing atrial fibrillation, respectively, compared with participants in the lowest quartile. The results persisted across sensitivity analyses. 

Thus, the study confirms that increased incident atrial fibrillation is seen in patients with increased visit-to-visit variability of systolic blood pressure in middle-aged and older populations. 

Further reading: 10.1097/HJH.0000000000003291 

Wang, Chia; Sun, Yizhena; Xin, Qiana, et al. Visit-to-visit SBP variability and risk of atrial fibrillation in middle-aged and older populations. Journal of Hypertension: October 11, 2022 - Volume - Issue - 10.1097/HJH.0000000000003291.