High Pulse Pressure: Risk Factor for New-Onset AFib?

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High Pulse Pressure: Risk Factor for New-Onset AFib?

The difference between systolic and diastolic blood pressure may portend atrial fibrillation, according to Framingham data.

Traditional risk factors for atrial fibrillation (AF) include advanced age, high systolic blood pressure, diabetes, heart failure, valvular heart disease, prior MI, and obesity, as well as echocardiographic evidence of left-atrial enlargement, left-ventricular wall thickness, and impaired LV systolic function. To study whether increased pulse pressure (PP) might also be an AF risk factor, researchers analyzed data from 5331 Framingham Heart Study participants (mean age, 57; 55% women) who were AF-free at baseline.

During a median follow-up of 12 years, 698 participants (13%) developed AF. As expected, traditional risk factors (including increased systolic BP) predicted new-onset AF. However, diastolic BP was also significantly, but inversely, related to AF risk in a multivariable-adjusted analysis (hazard ratio, 0.87, per 10-mm-Hg increment), and diastolic BP enhanced the value of the risk-prediction model. Increased PP — the difference between systolic and diastolic BP — was significantly, and directly, related to AF risk (HR, 1.26, per 20-mm-Hg increment). Notably, mean arterial pressure was not associated with AF risk.

Comment: Most AF studies have emphasized systolic, not diastolic, BP. The data from this large Framingham cohort show that diastolic BP, which typically causes concern when elevated, can be problematic when it’s low in relation to systolic BP. Elevated pulse pressure may be of particular concern in the elderly (see Journal Watch Cardiology Dec 15 2000). The authors propose that high PP may increase AF risk by increasing stress on the left atrium, but we don’t yet know whether high PP is a marker or an agent of risk for AF and whether modifying it can decrease that risk.

— Mark S. Link, MD

Published in Journal Watch Cardiology February 20, 2007