Blood pressure and in-hospital outcomes in patients hospitalized with atrial fibrillation: findings from the CCC-AF project.

Abstract

The relationship between blood pressure (BP) levels and adverse outcomes in patients with atrial fibrillation (AF) is incompletely understood. Our study aims to elucidate the relationship between BP levels upon admission and in-hospital outcomes in patients hospitalized with AF. Based on the Improving Care for Cardiovascular Disease in China-AF (CCC-AF) project, patients hospitalized with AF collected from 236 hospitals in China from 2015 to 2019 were included in current analysis. A total of 60 390 patients hospitalized with AF were included. Using systolic BP (SBP)/diastolic BP (DBP) of 130-139/80-89 mmHg upon admission as the reference, SBP/DBP ≥160/100 mmHg was associated with an increased risk of stroke/transient ischemic attack (TIA) (adjusted OR, 1.65; 95% CI, 1.27-2.15; P < 0.001) and heart failure (HF) (adjusted OR, 1.29; 95% CI, 1.18-1.41; P < 0.001). SBP/DBP < 120/ < 80 mmHg was associated with an increased risk of HF (adjusted OR, 1.24; 95% CI, 1.14-1.34; P < 0.001), and all-cause death (adjusted OR, 1.90; 95% CI, 1.90-3.86; P < 0.001). A similar pattern was observed in the analysis of the relationship between SBP and DBP levels and in-hospital outcomes, respectively. Among patients hospitalized with AF, higher BP levels upon admission are associated with an increased risk of stroke/TIA and HF, and lower BP levels are associated with an increased risk of HF and all-cause death. Hence, physicians should pay attention to higher and lower BP levels. Randomized trials to identify the optimal treatment target for AF patients are warranted.