Blood pressure variability and risk of new-onset atrial fibrillation: a systematic review of randomized trials of antihypertensive drugs.

Stroke; a Journal of Cerebral Circulation
Alastair John Stewart Webb, Peter Malcolm Rothwell

Abstract

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). 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. 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<0.0001), lower variance ratio was unrelated to new-onset AF either on meta-analysis (OR=1.02; 95% CI 0.90 to 1.15; 125 878 patients; 13 comparisons) or on metaregression (log OR versus log variance ratio of systolic blood pressure 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. Effects of randomized treatment on variability in BP are un...Continue Reading

References

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Citations

Apr 6, 2011·Current Hypertension Reports·Peter M Rothwell
Nov 21, 2012·Current Opinion in Nephrology and Hypertension·Patrick RossignolFaiez Zannad
Jan 30, 2013·Cell Calcium·Angelo O RosaMartin Morad
Jun 22, 2013·Clinical Cardiology·Marijana TadicCesare Cuspidi
Apr 15, 2016·American Journal of Hypertension·Panagiota VeloudiJames E Sharman
Jan 20, 2018·Circulation Research·Paolo VerdecchiaGianpaolo Reboldi
Sep 13, 2017·Hypertension·Mikhail S DzeshkaGregory Y H Lip
Jan 11, 2014·Stroke; a Journal of Cerebral Circulation·Alastair John Stewart Webb, Peter Malcolm Rothwell
Jun 27, 2014·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Gwo-Ping JongYi-sheng Liou
Jun 5, 2019·American Journal of Hypertension·Charalampos LoutradisAikaterini Papagianni
Jan 31, 2018·Critical Reviews in Food Science and Nutrition·GianLuca ColussiLeonardo A Sechi
Jan 10, 2019·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Charalampos LoutradisPantelis Sarafidis
Sep 17, 2013·Journal of Cardiovascular Pharmacology and Therapeutics·Nicolás Roberto RoblesRoman Hernandez-Gallego
Jan 5, 2021·Hypertension·Matthew C HymanScott M Damrauer
Oct 17, 2020·Annual Review of Physiology·Jordi HeijmanUlrich Schotten
Mar 7, 2020·Journal of Hypertension·Fabio AngeliPaolo Verdecchia

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