Optimal Blood Pressure in Patients with Atrial Fibrillation (from the AFFIRM Trial)

Apurva O. Badheka, Nileshkumar J. Patel, Peeyush M. Grover, Neeraj Shah, Nilay Patel, Vikas Singh, Abhishek J. Deshmukh, Kathan Mehta, Ankit Chothani, Ghanshyambhai T. Savani, Shilpkumar Arora, Ankit Rathod, George R. Marzouka, James Lafferty, Jawahar L. Mehta, Raul D. Mitrani

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19 Scopus citations

Abstract

Many medications used to treat atrial fibrillation (AF) also reduce blood pressure (BP). The relation between BP and mortality is unclear in patients with AF. We performed a post hoc analysis of 3,947 participants from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management trial. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) at baseline and follow-up were categorized by 10-mm Hg increments. The end points were all-cause mortality (ACM) and secondary outcome (combination of ACM, ventricular tachycardia and/or fibrillation, pulseless electrical activity, significant bradycardia, stroke, major bleeding, myocardial infarction, and pulmonary embolism). SBP and DBP followed a "U-shaped" curve with respect to primary and secondary outcomes after multivariate analysis. A nonlinear Cox proportional hazards model showed that the incidence of ACM was lowest at 140/78 mm Hg. Subgroup analyses revealed similar U-shaped curves. There was an increased ACM observed with BP <110/60 mm Hg (hazard ratio 2.4, p <0.01, respectively, for SBP and DBP). In conclusion, in patients with AF, U-shaped relation existed between BP and ACM. These data suggest that the optimal BP target in patients with AF may be greater than the general population and that pharmacologic therapy to treat AF may be associated with ACM or adverse events if BP is reduced to <110/60 mm Hg.

Original languageEnglish (US)
Pages (from-to)727-736
Number of pages10
JournalAmerican Journal of Cardiology
Volume114
Issue number5
DOIs
StatePublished - Sep 1 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Badheka, A. O., Patel, N. J., Grover, P. M., Shah, N., Patel, N., Singh, V., Deshmukh, A. J., Mehta, K., Chothani, A., Savani, G. T., Arora, S., Rathod, A., Marzouka, G. R., Lafferty, J., Mehta, J. L., & Mitrani, R. D. (2014). Optimal Blood Pressure in Patients with Atrial Fibrillation (from the AFFIRM Trial). American Journal of Cardiology, 114(5), 727-736. https://doi.org/10.1016/j.amjcard.2014.06.002