Visit-to-visit variability (VVV) in systolic blood pressure (SBP) was a strong predictor of stroke and major bleeding in patients with atrial fibrillation (AFib), according to results from the AFFIRM trial presented at ESC Congress 2017 in Barcelona.

The study looked at 3,843 patients with available SBPs at baseline and at least four available measurements. SBP-VVV was then categorized by quartile (1st <10.09, 2nd 10.09-13.85, 3rd 13.86-17.33, 4th ³17.34 mm Hg), and as a continuous variable. They study’s primary endpoints were stroke and major bleeding. Patients were followed for a mean of 3.6 years.

The results showed that a total of 149 (3.9 percent) of patients experienced a stroke, while 248 (6.5 percent) experienced a major bleeding event, with researchers noting a distinct pattern of increased risk with each elevation in quartile. Stroke rate progressively increased between the first and fourth SBP-VVV quartiles (2.5 percent, 3.0 percent, 3.8 percent and 6.2 percent, respectively; p < 0.001). Similarly, major bleeding rates were directly related to SBP-VVV quartiles (10.8 percent, 11.2 percent, 15.6 percent and 20.8 percent, respectively; p < 0 .001). Both a Kaplan-Meier analysis and a fully adjusted multivariate regression analysis indicated that those in the third and fourth SBP-VVV quartiles were at greatest risk for stroke and major bleeding. In addition to stroke and major bleeding results, researchers noted no difference in warfarin use by quartile (p = 0.443). However, they said time in therapeutic range was inversely related to quartiles (p < 0.001).

Moving forward, the study’s investigators said that attention to control of BP variability may improve outcomes in AFib patients. “Our findings suggest that consistency in blood pressure control, beyond the single measurement, is very important, and this appears to be the case across all types of AFib patients, irrespective of age, blood pressure history, blood pressure level or clotting risk,” said Marco Proietti, MD. “Interventions aimed at reducing blood pressure variability over the long term, such as optimizing the medications and improving adherence are strongly needed.”

Keywords: ESC Congress, ESC2017, Blood Pressure, Warfarin, Atrial Fibrillation, Kaplan-Meier Estimate, Hypertension, Blood Pressure Determination, Stroke, Hemorrhage

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