Impact of Blood Pressure Visit‐to‐Visit Variability on Adverse Events in Patients With Nonvalvular Atrial Fibrillation: Subanalysis of the J‐RHYTHM Registry
Eitaro Kodani, Hiroshi Inoue, Hirotsugu Atarashi, Ken Okumura, Takeshi Yamashita, Toshiaki Otsuka, Hideki Origasa, Hiroshi Inoue, Ken Okumura, Hirotsugu Atarashi, Takeshi Yamashita, M Sakurai, Yoshiaki Kawamura, Ken Okumura, I. Kubota, Yoshiaki Kaneko, Kazuo Matsumoto, Satoshi Ogawa, Hirotsugu Atarashi, Takeshi Yamashita, Hiroshi Inoue, Yoshiyasu Aizawa, I. Kodama, Eiichi Watanabe, Yukihiro Koretsune, Yuka Okuyama, Akihiko Shimizu, Osamu Igawa, Shigenobu Bando, M. Fukatani, Tetsunori Saikawa, Akiko Chishaki, Hideki Origasa, N Kato, Katsuya Kanda, J. Kato, Hiroaki Obata, Masashi Aoki, Hiroto Honda, Y. Konta, Toru Hatayama, Yukihiko Abe, Ken Terata, Takahide Yagi, Akihiko Ishida, T Komatsu, Hideaki Tachibana, Hidenori Suzuki, Yoshiyuki Kamiyama, Tomonori Watanabe, Masaki Oguma, M. Itoh, Osamu Hirono, Yuichi Tsunoda, Ken’ichi Ikeda, Tohru Kanaya, Kenzo Sakurai, Hiroyasu Sukekawa, Seigo Nakada, Taihei Itoh, Shoichi Tange, Mamoru Manita, Mutsuko Ohta, Hiromi Eguma, Ritsushi Kato, Yoshiko Endo, Tadayoshi Ogino, Masahiro Yamazaki, Hideaki Kanki, M Uchida, Satoru Miyanaga, Kentaro Shibayama, Notitaka Toratani, Toshiaki Kojima, Mari Ichikawa, Makoto Saito, Yuji Umeda, Takao Sawanobori, Hiroshi Sohara, S. Okubo, Tomoyuki Ōkubo, T Tokunaga, Osamu Kuboyama, Hiroshi Ito, Younosuke Kitahara, Koichi Sagara, Toshihiko Satoh, Eitaro Kodani, Kaoru Sugi, Yuya Kobayashi, Yukihito Higashi, Tomoe Katoh, Yudai Hirayama, Naoya Matsumoto, Makoto Takano, Takanori Ikeda, Satoru Yusu, Shinichi Niwano, Yuji Nakazato, Yuhei Kawano
Abstract
Background Blood pressure (BP) variability has reportedly been a risk factor for various clinical events. To clarify the influence of BP visit‐to‐visit variability on adverse events in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J‐RHYTHM Registry was performed. Methods and Results Of 7406 outpatients with nonvalvular atrial fibrillation from 158 institutions, 7226 (age, 69.7±9.9 years; men, 70.7%), in whom BP was measured 4 times or more (14.6±5.0 times) during the 2‐year follow‐up period or until occurrence of an event, constituted the study group. SD and coefficient of variation of BP values were calculated as BP variability. Thromboembolism, major hemorrhage, and all‐cause death occurred in 110 (1.5%), 121 (1.7%), and 168 (2.3%) patients, respectively. When patients were divided into quartiles of systolic BP‐SD (<8.20, 8.20–10.49, 10.50–13.19, and ≥13.20 mm Hg), hazard ratios (HRs) for all adverse events were significantly high in the highest quartile compared with the lowest quartile (HR, 2.00, 95% CI, 1.15–3.49, P =0.015 for thromboembolism; HR, 2.60, 95% CI, 1.36–4.97, P =0.004 for major hemorrhage; and HR, 1.85, 95% CI, 1.11–3.07, P =0.018 for all‐cause death) after adjusting for components of the CHA 2 DS 2 ‐VASc score, warfarin and antiplatelet use, atrial fibrillation type, BP measurement times, and others. These findings were consistent when BP‐coefficient of variation was used instead of BP‐SD. Conclusions Systolic BP visit‐to‐visit variability was significantly associated with all adverse events in patients with nonvalvular atrial fibrillation. Further studies are needed to clarify the causality between BP variability and adverse outcomes in patients with nonvalvular atrial fibrillation. Registration URL: https://www.umin.ac.jp/ctr/ ; Unique Identifier: UMIN000001569.