Blood pressure and in-hospital outcomes in patients hospitalized with atrial fibrillation: findings from the CCC-AF project. - National Genomics Data Center (CNCB-NGDC)

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

Zhaoqing Sun, Yongchen Hao, Jun Liu, Na Yang, Haimei Wang, Yue Qi, Dong Zhao, Jing Liu, CCC-AF Investigators

Author Information

Zhaoqing Sun: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Yongchen Hao: Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
Jun Liu: Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
Na Yang: Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
Haimei Wang: Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
Yue Qi: Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
Dong Zhao: Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
Jing Liu: Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China. jingliu@ccmu.edu.cn.

PMID: 39910265 DOI: 10.1038/s41440-025-02125-y

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.

Atrial fibrillation Blood pressure level Hypertension In-hospital outcomes

Kornej J, Borschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res. 2020;127:4��20. [DOI: 10.1161/CIRCRESAHA.120.316340]
Lippi G, Sanchis-Gomar F, Cervellin G Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int J Stroke. 2020. https://doi.org/10.1177/1747493019897870 .
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983��8. [DOI: 10.1161/01.STR.22.8.983]
Vermond RA, Geelhoed B, Verweij N, Tieleman RG, Van der Harst P, Hillege HL, et al. Incidence of Atrial Fibrillation and Relationship With Cardiovascular Events, Heart Failure, and Mortality: A Community-Based Study From the Netherlands. J Am Coll Cardiol. 2015;66:1000��7. [DOI: 10.1016/j.jacc.2015.06.1314]
Dzeshka MS, Shantsila A, Shantsila E, Lip GYH. Atrial Fibrillation and Hypertension. Hypertension. 2017;70:854��61. [DOI: 10.1161/HYPERTENSIONAHA.117.08934]
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021��104. [DOI: 10.1093/eurheartj/ehy339]
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa612 .
Bohm M, Brueckmann M, Eikelboom JW, Ezekowitz M, Frassdorf M, Hijazi Z, et al. Cardiovascular outcomes, bleeding risk, and achieved blood pressure in patients on long-term anticoagulation with the thrombin antagonist dabigatran or warfarin: data from the RE-LY trial. Eur Heart J. 2020;41:2848��59. [DOI: 10.1093/eurheartj/ehaa247]
Kim D, Yang PS, Kim TH, Jang E, Shin H, Kim HY, et al. Ideal Blood Pressure in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2018;72:1233��45. [DOI: 10.1016/j.jacc.2018.05.076]
Badheka AO, Patel NJ, Grover PM, Shah N, Patel N, Singh V, et al. Optimal blood pressure in patients with atrial fibrillation (from the AFFIRM Trial). The American journal of cardiology. 2014;114:727��36. [DOI: 10.1016/j.amjcard.2014.06.002]
Tremblay-Gravel M, Khairy P, Roy D, Leduc H, Wyse DG, Cadrin-Tourigny J, et al. Systolic blood pressure and mortality in patients with atrial fibrillation and heart failure: insights from the AFFIRM and AF-CHF studies. European journal of heart failure. 2014;16:1168��74. [DOI: 10.1002/ejhf.168]
Lip GY, Frison L, Grind M, Invetigators S. Effect of hypertension on anticoagulated patients with atrial fibrillation. Eur Heart J. 2007;28:752��9. [DOI: 10.1093/eurheartj/ehl504]
Krittayaphong R, Pumprueg S, Ratanasumawong K, Sairat P, Lip GYH, Investigators C-A. Average Systolic Blood Pressure and Clinical Outcomes in Patients with Atrial Fibrillation: Prospective Data from COOL-AF Registry. Clin Interv Aging. 2021;16:1835��46. [DOI: 10.2147/CIA.S335321]
Vemulapalli S, Inohara T, Kim S, Thomas L, Piccini JP, Patel MR, et al. Blood Pressure Control and Cardiovascular Outcomes in Patients With Atrial Fibrillation (From the ORBIT-AF Registry). The American journal of cardiology. 2019;123:1628��36. [DOI: 10.1016/j.amjcard.2019.02.010]
Rao MP, Halvorsen S, Wojdyla D, Thomas L, Alexander JH, Hylek EM, et al. Blood Pressure Control and Risk of Stroke or Systemic Embolism in Patients With Atrial Fibrillation: Results From the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) Trial. J Am Heart Assoc. 2015;4:e002015.
Hao Y, Liu J, Smith SC, Huo Y, Fonarow GC, Ge J, et al. Rationale and design of the improving Care for Cardiovascular Disease in China (CCC) project: a national registry to improve management of atrial fibrillation. BMJ Open. 2018;8:e020968. [DOI: 10.1136/bmjopen-2017-020968]
Vidal-Petiot E, Ford I, Greenlaw N, Ferrari R, Fox KM, Tardif JC, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet. 2016;388:2142��52. [DOI: 10.1016/S0140-6736(16)31326-5]
McEvoy JW, Chen Y, Rawlings A, Hoogeveen RC, Ballantyne CM, Blumenthal RS, et al. Diastolic Blood Pressure, Subclinical Myocardial Damage, and Cardiac Events: Implications for Blood Pressure Control. J Am Coll Cardiol. 2016;68:1713��22. [DOI: 10.1016/j.jacc.2016.07.754]
Li J, Somers VK, Gao X, Chen Z, Ju J, Lin Q, et al. Evaluation of Optimal Diastolic Blood Pressure Range Among Adults With Treated Systolic Blood Pressure Less Than 130 mm Hg. JAMA Netw Open. 2021;4:e2037554. [DOI: 10.1001/jamanetworkopen.2020.37554]
Banach M, Aronow WS. Blood pressure j-curve: current concepts. Curr Hypertens Rep. 2012;14:556��66. [DOI: 10.1007/s11906-012-0314-3]
January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74:104��32. [DOI: 10.1016/j.jacc.2019.01.011]
Huang C, Zhang S, Hua W. Current knowledge and management of atrial fibrillation: consensus of Chinese experts 2021. Chin J Cardiac Arrhyth. 2022;26:15��88.
Wong CX, Tse HF, Choi EK, Chao TF, Inoue K, Poppe K, et al. The burden of atrial fibrillation in the Asia-Pacific region. Nat Rev Cardiol. 2024;21:841��3. [DOI: 10.1038/s41569-024-01091-1]
Clark CE, McDonagh STJ, McManus RJ. Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis. J Hum Hypertens. 2019;33:352��64. [DOI: 10.1038/s41371-018-0153-z]
Stergiou GS, Kyriakoulis KG, Stambolliu E, Destounis A, Karpettas N, Kalogeropoulos P, et al. Blood pressure measurement in atrial fibrillation: review and meta-analysis of evidence on accuracy and clinical relevance. J Hypertens. 2019;37:2430��41. [DOI: 10.1097/HJH.0000000000002201]
Pagonas N, Schmidt S, Eysel J, Compton F, Hoffmann C, Seibert F, et al. Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring. Hypertension. 2013;62:579��84. [DOI: 10.1161/HYPERTENSIONAHA.113.01426]

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