systolic blood pressure variability and major adverse .../media/clinical/pdf-files...aug 17, 2017...
TRANSCRIPT
Systolic Blood Pressure Variability and
Major Adverse Outcomes in Patients with Atrial Fibrillation:
The AFFIRM Study
Marco Proietti, Giulio Francesco Romiti,
Brian Olshansky, Gregory Y.H. Lip
Disclosures
• Small Consulting Fee from Boehringer Ingelheim
Background
Dzeshka Am J Hypertens. 2017 [Epub] Lip JAMA 2015;313:1950
• An intimate relationship exist between hypertension and atrial fibrillation (AF),
also affecting clinical outcomes
Background
Muntner Ann Intern Med. 2015;163:329 Gosmanova JACC 2017;68:1375
• Systolic blood pressure visit-to-visit variability (SBP-VVV) influences outcomes in non-AF cohorts
• No data are available about SBP-VVV role in AF populations
Aims
• We evaluated relationships between SBP-VVV and outcomes in patients with AF
Methods
• Data from the AFFIRM Trial were used.
• SBP-VVV was defined according to the standard deviation of SBP measurements from
baseline to follow-up. Patients with available SBPs at baseline and with at least 4 available
measurements were eligible. SBP-VVV was categorised by quartile (1st <10.09, 2nd 10.09-
13.85, 3rd 13.86-17.33, 4th≥17.34 mmHg), and as a continuous variable.
• Stroke and major bleeding were the measured outcomes.
Results
• Among the original 4060 patients enrolled, 3843 (94.7%) were eligible
*p<0.05; **p<0.001
Results
*both p<0.001
Median FU: 3.6 years
Results
ResultsMultivariate Analysis*
HR 95% CI p
Stroke
SBP SD Quartiles
1st Quartile (ref.)
2nd Quartile
3rd Quartile
4th Quartile
-
1.42
1.85
2.33
-
0.76-2.66
1.02-3.35
1.30-4.16
-
0.276
0.042
0.004
SBP SD (per mmHg) 1.06 1.02-1.10 0.002
Major Bleeding
SBP SD Quartiles
1st Quartile (ref.)
2nd Quartile
3rd Quartile
4th Quartile
-
1.34
1.92
2.88
-
0.79-2.28
1.18-3.15
1.79-4.61
-
0.278
0.009
<0.001
SBP SD (per mmHg) 1.08 1.05-1.11 <0.001
*Adjusted for Use of Warfarin, Time in Therapeutic Range, Hepatic/Renal Disease, Pulmonary Disease, Randomized Treatment, Congestive
Heart Failure, Hypertension, Age, Diabetes Mellitus, Stroke/Transient Ischemic Attack, Myocardial Infarction, Peripheral Arterial Disease, Sex
Conclusions
• Over long term follow-up, SBP-VVV is a potent predictor of stroke
and major bleeding in patients with AF.
• Attention to BP variability may improve clinical outcomes in
patients with AF.