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Atrial fibrillation and blood pressure: more than just a number (AFFIRM)

Barcelona, Spain – 28 Aug 2017: New research presented at ESC Congress today shows, for the first time, that blood pressure control is pivotal in reducing major bleeding and stroke risk in patients with atrial fibrillation (AF).

The range of variability in a patient’s systolic blood pressure (SBP) from visit to visit was strongly associated with their risk of adverse outcomes, reported Dr Marco Proietti, MD, from the Institute of Cardiovascular Sciences, University of Birmingham.

“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 optimizing the medications and improving adherence are strongly needed,” he added.

The study was a post-hoc analysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, a prospective randomized comparison of two treatment strategies in patients with AF.

In total, 3,843 patients from AFFIRM were included in the current analysis, for whom visit-to-visit variability (VVV) in mean SBP had been recorded at 2, 4, 8 and 12 months and then every 4 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 10.09 mmHg from visit to visit (1st quartile); and then those with variations of10.09-13.85 mmHg (2nd), 13.86-17.33 mmHg (3rd) and ≥17.34 mmHg (4th).

After a mean follow-up of 3.6 years, 149 strokes and 248 major bleeding events had been recorded, with a clear pattern of increasing risk with each elevation in quartile.

Specifically stroke rate progressively increased from 2.5% to 3.0% 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 (10.8%, 11.2%, 15.6%, 20.8% 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 (hazard ratio [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).

Dr. Proietti said these outcomes will likely translate to higher mortality in patients in the higher quartiles.

“A better effort in controlling blood pressure in the clinical follow-up is pivotal to obtain a better management of patients with atrial fibrillation and improvement of outcomes”, he reiterated.


Notes to editor

Sources of funding: The AFFIRM study was funded by the United States National Heart, Lung, and Blood Institute.

Disclosures: Dr. Proietti disclosed consulting fee from Boehringer Ingelheim.

References and notes
The study “Systolic Blood Pressure Variability and Major Adverse Outcomes in Patients with Atrial Fibrillation: the AFFIRM Study” will be presented during:
·    The press conference Clinical Trial Update 1 on Sunday 27August from 14:30 to 15:30.
·    The session Clinical Trial Update 1 on Monday 28 August from 14:00 to 15:30, in Dali - The Hub.

ESC Press Office
For more information, please contact the ESC Press Office:
For press enquiries, independent comment on-site, please contact, the Media & Press Coordinator Jacques Olivier COSTA: +34 666 509 856
The press conference timetable is available here.

To access all the scientific resources from the sessions during the congress, visit ESC Congress 365.  

About the European Society of Cardiology
The European Society of Cardiology brings together health care professionals from more than 140 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2017
ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2017 takes place 26 to 30 August at the Fira Gran Via in Barcelona, Spain. The scientific programme is here. More information is available from the ESC Press Office at

This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2017. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.