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Optimal blood pressure in patients with atrial fibrillation (from the AFFIRM Trial).

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Citation: American Journal of Cardiology. 114(5):727-36, 2014 Sep 1.PMID: 25060415Institution: MedStar Washington Hospital CenterDepartment: Medicine/General Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | Multicenter Study | Randomized Controlled TrialSubject headings: *Anti-Arrhythmia Agents/tu [Therapeutic Use] | *Atrial Fibrillation/pp [Physiopathology] | *Blood Pressure/ph [Physiology] | Aged | Atrial Fibrillation/dt [Drug Therapy] | Blood Pressure Determination | Blood Pressure/de [Drug Effects] | Female | Follow-Up Studies | Heart Rate/de [Drug Effects] | Heart Rate/ph [Physiology] | Humans | Male | Retrospective Studies | Time Factors | Treatment OutcomeYear: 2014 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:

0002-9149

Name of journal: The American journal of cardiologyAbstract: 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. Copyright 2014 Elsevier Inc. All rights reserved.All authors: Arora S, Badheka AO, Chothani A, Deshmukh AJ, Grover PM, Lafferty J, Marzouka GR, Mehta JL, Mehta K, Mitrani RD, Patel N, Patel NJ, Rathod A, Savani GT, Shah N, Singh VFiscal year: FY2015Digital Object Identifier:

http://dx.doi.org/10.1016/j.amjcard.2014.06.002

Date added to catalog: 2014-11-25

Holdings ( 1 )
Title notes ( 3 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	25060415	Available		25060415

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

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. Copyright 2014 Elsevier Inc. All rights reserved.

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