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Boos CJ, Hein A, Wardill T, Diamondali S, Wai S, O'Kane P, Khattab A. The relationship between ambulatory arterial stiffness index and incident atrial fibrillation. Clin Cardiol 2024; 47:e24299. [PMID: 38873860 PMCID: PMC11177039 DOI: 10.1002/clc.24299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 05/03/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The ambulatory arterial stiffness index (AASI) is an indirect measure of blood pressure variability and arterial stiffness which are atrial fibrillation (AF) risk factors. The relationship between AASI and AF development has not been previously investigated and was the primary aim of this study. METHODS This was an observational cohort study of adults (aged 18-85 years) in sinus rhythm, who underwent 24-h ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension or its control. RESULTS Eight hundred and twenty-one patients (49% men) aged 58.7 ± 15.3 years were followed up for a median of 4.0 years (3317 patient-years). In total, 75 patients (9.1%) developed ≥1 AF episode during follow-up. The mean AASI was 0.46 ± 0.17 (median 0.46). AASI values (0.52 ± 0.16 vs. 0.45 ± 0.17; p < .001) and the proportion of AASI values above the median (65.3% vs. 48.4%; p = .005) were greater among the patients who developed AF versus those that did not respectively. AASI significantly correlated with age (r = .49; 95% confidence interval: 0.44-0.54: p < .001). On Kaplan-Meier analysis, higher baseline AASI by median, tertiles, and quartiles were all significantly associated with AF development (X2: 10.13; p < .001). On Cox regression analyses, both a 1-standard deviation increase and AASI > median were independent predictors of AF, but this relationship was no longer significant when age was included in the model. CONCLUSIONS AASI is an independent predictor of AF development. However, this relationship becomes insignificant after adjustment for age which is higher correlated with AASI.
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Affiliation(s)
- Christopher J. Boos
- Department of CardiologyUniversity Hospitals DorsetDorsetUK
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Aung Hein
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Tom Wardill
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Sadaf Diamondali
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Su Wai
- Department of CardiologyUniversity Hospitals DorsetDorsetUK
| | - Peter O'Kane
- Department of CardiologyUniversity Hospitals DorsetDorsetUK
| | - Ahmed Khattab
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
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Pucci G, Grillo A, Dalakleidi KV, Fraenkel E, Gkaliagkousi E, Golemati S, Guala A, Hametner B, Lazaridis A, Mayer CC, Mozos I, Pereira T, Veerasingam D, Terentes-Printzios D, Agnoletti D. Atrial Fibrillation and Early Vascular Aging: Clinical Implications, Methodology Issues and Open Questions-A Review from the VascAgeNet COST Action. J Clin Med 2024; 13:1207. [PMID: 38592046 PMCID: PMC10931681 DOI: 10.3390/jcm13051207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/02/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
Atrial fibrillation (AF), the most common cardiac arrhythmia, is associated with adverse CV outcomes. Vascular aging (VA), which is defined as the progressive deterioration of arterial function and structure over a lifetime, is an independent predictor of both AF development and CV events. A timing identification and treatment of early VA has therefore the potential to reduce the risk of AF incidence and related CV events. A network of scientists and clinicians from the COST Action VascAgeNet identified five clinically and methodologically relevant questions regarding the relationship between AF and VA and conducted a narrative review of the literature to find potential answers. These are: (1) Are VA biomarkers associated with AF? (2) Does early VA predict AF occurrence better than chronological aging? (3) Is early VA a risk enhancer for the occurrence of CV events in AF patients? (4) Are devices measuring VA suitable to perform subclinical AF detection? (5) Does atrial-fibrillation-related rhythm irregularity have a negative impact on the measurement of vascular age? Results showed that VA is a powerful and independent predictor of AF incidence, however, its role as risk modifier for the occurrence of CV events in patients with AF is debatable. Limited and inconclusive data exist regarding the reliability of VA measurement in the presence of rhythm irregularities associated with AF. To date, no device is equipped with tools capable of detecting AF during VA measurements. This represents a missed opportunity to effectively perform CV prevention in people at high risk. Further advances are needed to fill knowledge gaps in this field.
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Affiliation(s)
- Giacomo Pucci
- Unit of Internal Medicine, Santa Maria University Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06125 Perugia, Italy
| | - Andrea Grillo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Kalliopi V Dalakleidi
- Biomedical Simulations and Imaging (BIOSIM) Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | - Emil Fraenkel
- 1st Department of Internal Medicine, Faculty of General Medicine, Pavol Jozef Šafárik University, 04011 Košice, Slovakia
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 54124 Thessaloniki, Greece
| | - Spyretta Golemati
- Medical School, National and Kapodistrian University of Athens, 10675 Athens, Greece
| | - Andrea Guala
- Vall d'Hebrón Research Institute (VHIR), 08035 Barcelona, Spain
- CIBER CV, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Bernhard Hametner
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Medical Signal Analysis, 1210 Vienna, Austria
| | - Antonios Lazaridis
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 54124 Thessaloniki, Greece
| | - Christopher C Mayer
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Medical Signal Analysis, 1210 Vienna, Austria
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, 300173 Timisoara, Romania
| | - Telmo Pereira
- H&TRC-Health & Technology Research Center, Coimbra Health School, Polytechnic University of Coimbra, 3000-331 Coimbra, Portugal
- Laboratory for Applied Research in Health (Labinsaúde), Polytechnic University of Coimbra, 3000-331 Coimbra, Portugal
| | - Dave Veerasingam
- Department of Cardiothoracic Surgery, Galway University Hospitals, H91 YR71 Galway, Ireland
| | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Davide Agnoletti
- Cardiovascular Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Cardiovascular Internal Medicine, Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy
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3
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Aune D, Mahamat-Saleh Y, Kobeissi E, Feng T, Heath AK, Janszky I. Blood pressure, hypertension and the risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies. Eur J Epidemiol 2023; 38:145-178. [PMID: 36626102 PMCID: PMC9905193 DOI: 10.1007/s10654-022-00914-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/06/2022] [Indexed: 01/11/2023]
Abstract
Elevated blood pressure and hypertension have been associated with increased risk of atrial fibrillation in a number of epidemiological studies, however, the strength of the association has differed between studies. We conducted a systematic review and meta-analysis of the association between blood pressure and hypertension and atrial fibrillation. PubMed and Embase databases were searched for studies of hypertension and blood pressure and atrial fibrillation up to June 6th 2022. Cohort studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of atrial fibrillation associated with hypertension or blood pressure were included. A random effects model was used to estimate summary RRs. Sixty eight cohort studies were included in the meta-analysis. The summary RR was 1.50 (95% CI: 1.42-1.58, I2 = 98.1%, n = 56 studies) for people with hypertension compared to those without hypertension (1,080,611 cases, 30,539,230 participants), 1.18 (95% CI: 1.16-1.21, I2 = 65.9%, n = 37 studies) per 20 mmHg increase in systolic blood pressure (346,471 cases, 14,569,396 participants), and 1.07 (95% CI: 1.03-1.11, I2 = 91.5%, n = 22 studies) per 10 mmHg increase in diastolic blood pressure (332,867 cases, 14,354,980 participants). There was evidence of a nonlinear association between diastolic blood pressure and atrial fibrillation with a steeper increase in risk at lower levels of diastolic blood pressure, but for systolic blood pressure the association appeared to be linear. For both systolic and diastolic blood pressure, the risk increased even within the normal range of blood pressure and persons at the high end of systolic and diastolic blood pressure around 180/110 mmHg had a 1.8-2.3 fold higher risk of atrial fibrillation compared to those with a blood pressure of 90/60 mmHg. These results suggest that elevated blood pressure and hypertension increases the risk of atrial fibrillation and there is some increase in risk even within the normal range of systolic and diastolic blood pressure.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK.
- Department of Nutrition, Bjørknes University College, Oslo, Norway.
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | | | - Elsa Kobeissi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Tingting Feng
- Norwegian Registry for Vascular Surgery, Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Imre Janszky
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Abstract
The global prevalence of atrial fibrillation (AF) has increased substantially over the past three decades and is currently approximately 60 million cases. Incident AF and its clinical consequences are largely the result of risk factors that can be modified by lifestyle changes. In this Review, we provide evidence that the lifetime risk of AF is modified not only by sex and race but also through the clinical risk factor and comorbidity burden of individual patients. We begin by summarizing the epidemiology of AF, focusing on non-modifiable and modifiable risk factors, as well as targets and strategies for the primary prevention of AF. Furthermore, we evaluate the role of modifiable risk factors in the secondary prevention of AF as well as the potential effects of risk factor interventions on the frequency and severity of subsequent AF episodes. We end the Review by proposing strategies that require evaluation as well as global policy changes that are needed for the prevention of incident AF and the management of recurrent episodes in patients already affected by AF.
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Huang PH, Huang CC, Lin SJ, Chen JW. Prediction of atrial fibrillation in patients with hypertension: A comprehensive comparison of office and ambulatory blood pressure measurements. J Clin Hypertens (Greenwich) 2022; 24:838-847. [PMID: 35695288 PMCID: PMC9278568 DOI: 10.1111/jch.14524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/21/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022]
Abstract
Hypertension is associated with the development of atrial fibrillation (AF). Evidence has shown that reverse dipping pattern, an abnormal increase of night-time blood pressure (BP) comparing to daytime BP, is associated with cardiovascular events. However, the relationship between diurnal changes in BP and AF has not been sufficiently explored. This paper aims to cross-sectionally explore the relationship between AF and ambulatory BP parameters, especially reverse dippers to the others, and further longitudinally analyze how BP patterns are associated to the risk of developing new-onset AF. Between February 2012 and March 2021, five out of 412 patients were identified of AF at baseline; four were reverse dippers (3.7%) and one was from the others (.3%). Cross-sectionally, the multivariate logistic regression analysis showed that reverse dippers were significantly more likely to have AF (odds ratio: 12.39, p = .030). After excluding patients with baseline AF, during the mean follow-up of 4.6 ± 3.0 years, seven patients developed AF. Longitudinally, the multivariate Cox regression analysis revealed that 24-h systolic BP (hazard ratio per 10 mmHg: 2.12, p = .015), night-time systolic BP (hazard ratio per 10 mmHg: 2.27, p = .002), and presentation of reverse dipping (hazard ratio: 5.25, p = .042) were independently associated with new-onset AF. None of the office BP measurements were associated with new-onset AF. While ambulatory BP measurements were better predictors for the incidence of AF, careful management is necessary for reverse dippers as they are at high risk of developing AF.
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Affiliation(s)
- Pin-Hsiang Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Office of Medical Education, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
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Matsumoto K, Jin Z, Homma S, Elkind MSV, Schwartz JE, Rundek T, Mannina C, Ito K, Sacco RL, Di Tullio MR. Office, Central, and Ambulatory Blood Pressure for Predicting First Stroke in Older Adults: A Community-Based Cohort Study. Hypertension 2021; 78:851-858. [PMID: 34247509 DOI: 10.1161/hypertensionaha.121.17308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Kenji Matsumoto
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics (Z.J.), Columbia University, New York, NY
| | - Shunichi Homma
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Mitchell S V Elkind
- Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY (M.S.V.E.)
| | - Joseph E Schwartz
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY.,Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S.)
| | - Tatjana Rundek
- Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL
| | - Carlo Mannina
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Kazato Ito
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Ralph L Sacco
- Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Clinical and Translational Science Institute (R.L.S.), Miller School of Medicine, University of Miami, FL
| | - Marco R Di Tullio
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
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Reply. J Hypertens 2021; 39:1261-1262. [PMID: 33967220 DOI: 10.1097/hjh.0000000000002825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Coccina F, Pierdomenico AM, De Rosa M, Lorenzo B, Foglietta M, Petrilli I, Vitulli P, Pizzicannella J, Trubiani O, Cipollone F, Renda G, Pierdomenico SD. Risk of Atrial Fibrillation in Masked and White Coat Uncontrolled Hypertension. Am J Hypertens 2021; 34:504-510. [PMID: 33186441 DOI: 10.1093/ajh/hpaa185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/17/2020] [Accepted: 11/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Risk of atrial fibrillation (AF) in masked and white coat uncontrolled hypertension (MUCH and WUCH, respectively) has not yet been investigated. We assessed the risk of new-onset AF in MUCH and WUCH detected by ambulatory blood pressure (BP) monitoring. METHODS The occurrence of AF was evaluated in 2,135 treated hypertensive patients aged >40 years, with baseline sinus rhythm, by electrocardiogram. Controlled hypertension (CH) was defined as clinic BP <140/90 mm Hg and daytime BP, regardless of nighttime BP, <135/85 mm Hg, MUCH as clinic BP <140/90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg, WUCH as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP <135/85 mm Hg, and sustained uncontrolled hypertension (SUCH) as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg. RESULTS MUCH was identified in 203 patients (9.5% of all the population, 29% of those with normal clinic BP) and WUCH in 503 patients (23.5% of all the population, 35% of those with high clinic BP). During the follow-up (mean 9.7 years), 116 cases of AF occurred. After adjustment for covariates, patients with MUCH (hazard ratio 2.02, 95% confidence interval, 1.06-3.85) and SUCH (hazard ratio 1.83, 95% confidence interval, 1.04-3.21) had higher risk of new-onset AF than those with CH, whereas those with WUCH (hazard ratio 1.12, 95% confidence interval, 0.59-2.13) did not. CONCLUSIONS When compared with patients with CH, those with MUCH and SUCH are at higher risk (approximately doubled) of new-onset AF, whereas those with WUCH are not.
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Affiliation(s)
- Francesca Coccina
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Anna M Pierdomenico
- Department of Medicine and Aging Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Matteo De Rosa
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Belli Lorenzo
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Melissa Foglietta
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Ivan Petrilli
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Piergiusto Vitulli
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Jacopo Pizzicannella
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Oriana Trubiani
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Giulia Renda
- Department of Neurosciences, Imaging and Clinical Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Sante D Pierdomenico
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
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10
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Coccina F, Pierdomenico AM, De Rosa M, Cuccurullo C, Pierdomenico SD. Association of clinic and ambulatory blood pressure with new-onset atrial fibrillation: A meta-analysis of observational studies. J Clin Hypertens (Greenwich) 2021; 23:1104-1111. [PMID: 33951286 PMCID: PMC8678663 DOI: 10.1111/jch.14256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to perform a meta‐analysis of studies evaluating the association of clinic and daytime, nighttime, and 24‐h blood pressure with the occurrence of new‐onset atrial fibrillation. We conducted a literature search through PubMed, Web of science, and Cochrane Library for articles evaluating the occurrence of new‐onset atrial fibrillation in relation to the above‐mentioned blood pressure parameters and reporting adjusted hazard ratio and 95% confidence interval. We identified five studies. The pooled population consisted of 7224 patients who experienced 444 cases of atrial fibrillation. The overall adjusted hazard ratio (95% confidence interval) was 1.05 (0.98‐1.13), 1.19 (1.11‐1.27), 1.18 (1.11‐1.26), and 1.23 (1.14‐1.32), per 10‐mmHg increment in clinic, daytime, nighttime, and 24‐h systolic blood pressure, respectively. The degree of heterogeneity of the hazard ratio estimates across the studies (Q and I‐squared statistics) were minimal. The results of this meta‐analysis strongly suggest that ambulatory systolic blood pressure prospectively predicts incident atrial fibrillation better than does clinic systolic blood pressure and that daytime, nighttime, and 24‐h systolic blood pressure are similarly associated with future atrial fibrillation.
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Affiliation(s)
- Francesca Coccina
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Anna M Pierdomenico
- Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Matteo De Rosa
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Chiara Cuccurullo
- Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Sante D Pierdomenico
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
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