Author + information
- Nileshkumar J. Patel,
- Neeraj Shah,
- Peeyush Grover,
- Vikas Singh,
- George R. Marzouka,
- Valay Parikh,
- Abhishek Deshmukh,
- Ankit Rathod,
- Apurva O. Badheka,
- James Lafferty,
- Jay L. Mehta and
- Raul D. Mitrani
The exact relationship between blood pressure (BP) and mortality is unclear in a population of patients with atrial fibrillation (AF).
We performed a post hoc analysis of 3,947 participants from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Trial. Systolic (SBP) and diastolic blood pressures (DBP) at baseline and up to one-year follow-up were categorized in 10-mm Hg increments. The primary outcome was all cause mortality (ACM). The secondary outcome was a composite of ACM, sustained ventricular tachycardia, ventricular fibrillation, pulseless electrical activity, clinically significant bradycardia, stroke, major bleeding, myocardial infarction and pulmonary embolism. A subanalysis was performed for the rate and rhythm control arms, and after excluding for coronary artery disease (CAD) population.
SBP and DBP followed a “J 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 with (SBP/DBP) of 140.2/78.2 mm Hg. Similar “J shaped” curves were also obtained for rate control, rhythm control, as well as a population excluding CAD.
In a population of patients with AF, A J-shaped relationship existed between BP, ACM and secondary outcome with the lowest expected event rates in the range SBP: 130–140 mm Hg and DBP: 70–80 mm Hg. Low BP (< 110/60 mm Hg) seemed to be more dangerous than high BP in the AF population.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT VII
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1236-38
- 2013 American College of Cardiology Foundation