Blood Pressure Variability and Risk of New-Onset Atrial Fibrillation
- 1 September 2010
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 41 (9), 2091-2093
- https://doi.org/10.1161/strokeaha.110.589531
Abstract
Background and Purpose— Increased visit-to-visit variability in blood pressure (BP) is a powerful risk factor for stroke, but the mechanism is uncertain. We hypothesized that BP variability might affect the risk of new atrial fibrillation (AF). Methods— We did a systematic review of large randomized controlled trials reporting new-onset AF by treatment allocation, excluding studies in heart failure and acute myocardial infarction. Estimates of the risk of new AF by treatment allocation were related to effects of treatment on group variability in BP. Results— Of 94 eligible randomized controlled trials, 14 reported rates of new AF. Although there was considerable heterogeneity between trials in effects of treatment on variance ratio ( P r 2 =0.109, P =0.270). Angiotensin receptor blockers tended to reduce new-onset AF (OR 0.85; 95% CI 0.71 to 1.01; P =0.067; 4 trials; 47 482 patients) with significant reductions in 2 individual trials but had no consistent reduction on variability in BP. Conclusions— Effects of randomized treatment on variability in BP are unrelated to risk of new-onset AF, suggesting that other mechanisms account for the link between variability and stroke risk. However, a lower incidence of AF in patients randomized to angiotensin receptor blockers may explain reductions in stroke risk in some trials.Keywords
This publication has 13 references indexed in Scilit:
- Effects of β blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of strokeThe Lancet Neurology, 2010
- Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertensionThe Lancet, 2010
- Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertensionThe Lancet, 2010
- Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysisThe Lancet, 2010
- Atrial Fibrillation at Baseline and During Follow-Up in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)Journal of the American College of Cardiology, 2009
- Atrial Fibrillation and Isolated Systolic HypertensionHypertension, 2008
- Reduced incidence of new-onset atrial fibrillation with angiotensin II receptor blockade: the VALUE trialJournal Of Hypertension, 2008
- Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenololJournal of the American College of Cardiology, 2005
- Major Cardiovascular Events in Hypertensive Patients Randomized to Doxazosin vs Chlorthalidone: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)JAMA, 2000
- Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 studyThe Lancet, 1999