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Blood pressure control is pivotal in reducing major bleeding and stroke risk in patients with atrial fibrillation (AF), and systolic blood pressure visit-to-visit variability (SBP-VVV) is a “potent predictor” of such events over long-term follow-up, according to new research presented yesterday by reported Doctor Marco Proietti (Institute of Cardiovascular Sciences, University of Birmingham, UK).
The study was a post-hoc analysis of the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial, a prospective randomised comparison of two treatment strategies for AF patients. In total, 3,843 patients from AFFIRM were included in the current analysis, for whom VVV in mean SBP had been recorded at two, four, eight and 12 months, and then every four months after enrolment. The patients were categorised into four quartiles based on their mean standard deviation in SBP: those who SBP varied by less than 10.09mmHg from
In total, 3,843 patients from AFFIRM were included in the current analysis, for whom VVV in mean SBP had been recorded at two, four, eight and 12 months, and then every four months after enrolment. The patients were categorised into four quartiles based on their mean standard deviation in SBP: those who SBP varied by less than 10.09mmHg from visit to visit (first quartile); and those with variations of 10.09–13.85mmHg (second), 13.86–17.33mmHg (third) and ≥17.34mmHg (fourth).
After a mean follow-up of 3.6 years, 149 strokes and 248 major bleeding events had been recorded, with a pattern of increasing risk with each elevation in quartile. Specifically, stroke rate progressively increased from 2.5% to 3% to 3.8% and 6.2% from the first to the fourth quartile (p<0.001) and similarly, the major bleeding rate was directly related to SBP-VVV quartiles (3.9%, 4.3%, 6.8%, 10.8% respectively; p<0.001).
After adjusting for variables, the analysis showed that patients in the third and fourth quartiles were at significantly increased risk of stroke (HR 1.85 and 2.33, p=0.042 and p=0.004, respectively) and major bleeding (HR 1.92 and 2.88, p=0.009 and p<0.001, respectively).
“Our findings suggest that consistency in blood pressure control, beyond the single measurement, is very important, and this appears to be the case across all types of AF patients, irrespective of age, blood pressure history, blood pressure level or clotting risk,” said Dr. Proietti.
“Interventions aimed at reducing blood pressure variability over the long term, such as optimising the medications and improving adherence, are strongly needed,” he added.
Resources of the presentation: Systolic Blood Pressure Variability and Major Adverse Outcomes in Patients with Atrial Fibrillation: the AFFIRM Study
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