The following is a summary of “Higher Cumulative Blood Pressure in Midlife Predicts an Increased Risk of Atrial Fibrillation: Evidence From the Atherosclerosis Risk in Communities Study,” published in the December 2023 issue of Cardiology by Cheng et al.

This study sought to examine the relationship between cumulative blood pressure (BP) exposure in midlife and the onset of atrial fibrillation (AF) in mid-to-late life, as prior research has established a connection between elevated BP and heightened AF risk. The investigation drew upon data from the ARIC (Atherosclerosis Risk in Communities) study, encompassing participants without prevalent AF at baseline and featuring four consecutive BP measurements. Cumulative BP exposure was calculated as the area under the curve from the first to the fourth visit.

Incident AF cases were identified through ECGs at study visits, hospital discharge codes, or death certificates. Among the 9,892 participants included (44.6% men, mean age 62.9±5.7 years at visit 4), 1,550 individuals (15.7%) developed new-onset AF over an average follow-up of 15.4 years. The incidence rates of AF per 1000 person-years showed an upward trend across the quartiles of cumulative systolic BP, ranging from 7.9 to 16.9. Following multivariable adjustments, participants in the highest quartile of cumulative systolic BP, pulse pressure, and mean arterial pressure exhibited hazard ratios of 1.48 (95% CI, 1.27–1.72), 1.81 (95% CI, 1.53–2.13), and 1.22 (95% CI, 1.05–1.41), respectively, in comparison to those in the lowest quartile, signifying an increased risk of incident AF. Additionally, incorporating cumulative systolic BP or pulse pressure modestly enhanced the predictive ability for new-onset AF. 

These findings highlight a substantial association between elevated cumulative systolic BP, pulse pressure, and mean arterial pressure and a heightened risk of developing incident AF, underscoring the potential significance of cumulative BP exposure as a risk factor for AF occurrence.

Source: ahajournals.org/doi/10.1161/JAHA.123.030409