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.