BLOOD PRESSURE IN ATRIAL FIBRILLATION AND IN SINUS RHYTHM DURING 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING: DATA FROM THE TEMPLAR PROJECT

J Hypertens. 2022 Jun 1;40(Suppl 1):e9. doi: 10.1097/01.hjh.0000835372.81237.9d.

ABSTRACT

OBJECTIVE: Hypertension is the most common risk factor for atrial fibrillation (AF), and accounts for a worse prognosis. Blood pressure (BP) control is accordingly essential in AF. However, the interpretation of BP levels is difficult in AF, since differences may be dependent on rhythm, particularly when using automated oscillometric devices. We used data from the TEMPLAR project to compare oscillometric ambulatory BP monitoring (ABPM) intra-individually in AF and sinus rhythm (SR).

DESIGN AND METHOD: Among the 4398 individuals in TEMPLAR > 65 years investigated with ABPM and Afib Microlife detector (rhythm indicated with each BP measurement), those with > 30% of readings indicating AF were selected (as previously recommended), and episodes > 30 mins for AF and SR were chosen. Systolic and diastolic BP, mean arterial pressure (MAP), pulse pressure (PP), averaged real variability (ARV), and its coefficient of variation (CV) were assessed for AF and SR, separated for 24 h, daytime, night-time, and for heart rate (HR) < = 90 and > = 90 bpm.

RESULTS: We included 430 individuals (mean age 78 ± 7 years, 57% females, 77% with hypertension and 72% on treatment, 4% with previous AF). Mean BP of all measurements included were 124.2/69.0, 126.3/71.1, and 119.5/64.0 mmHg, for 24 h, daytime, and night-time, respectively. There were no differences in MAP for AF vs SR (p = 0.47). Systolic BP tended to be lower in AF (24 h 123.6 ± 13.9 vs 124.7 ± 16.1 mmHg in SR, p = 0.05), and night-time diastolic BP was higher in AF (64.6 ± 10.9 vs 63.3 ± 10.4 mmHg in SR, p = 0.01). PP was lower in AF (24 h 54.6 ± 10.9 vs 55.7 ± 12.8 mmHg in SR, p = 0.002). Diastolic, but not systolic BP variability (ARV and CV) was higher in AF (24 h, p < 0.001). Results were similar with HR < = 90 and > = 90 bpm.

CONCLUSIONS: Using an oscillometric ABPM device, our results suggest that MAP is similar and reliable in both AF and SR. Lower systolic and higher diastolic BP in AF affects PP, which together with a high variability might impact arterial structure. However, differences in absolute numbers are small, and do not imply different BP strategies and target values in AF.

PMID:36027505 | DOI:10.1097/01.hjh.0000835372.81237.9d