PREDICTIVE VALUE OF VARIOUS BLOOD PRESSURE INDICES FOR ADVERSE EVENTS IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION: THE J-RHYTHM REGISTRY

Objective: Various blood pressure (BP) indices are reportedly associated with the incidence of adverse events in patients with hypertension and other cardiovascular diseases. This study aimed to explore predictive value for adverse events among several BP indices, including the indices of single BP measurement (systolic BP [SBP] at baseline and at the time closest to an event or at the last visit of follow-up [SBP-end]), indices of visit-to-visit BP variability (SBP standard deviation [SBP-SD] and coefficient of variation [SBP-CV]), and indices of BP consistency (SBP time in target range [SBP-TTR] and frequency in range [SBP-FIR]), in patients with non-valvular atrial fibrillation (NVAF), using data from the J-RHYTHM Registry. Design and method: Of 7406 outpatients with NVAF, 7226 (age, 69.7±9.9 years; men, 70.7%), in whom BP was measured 4 times or more (14.6±5.0 times) during the 2-year follow-up period or until occurrence of an event, were included. The SBP-TTR was calculated by the Rosendaal method and target SBP range was set between 110 and 130 mmHg. Predictive value of each index for adverse events was evaluated by the area under receiver-operating-characteristic curve (AUC) and compared by the DeLong's test. Results: AUCs of these indices for thromboembolism, major hemorrhage, and all-cause death were 0.51, 0.55, and 0.57 for baseline SBP; 0.67, 0.55, and 0.70 for SBP-end; 0.62, 0.64, and 0.63 for SBP-SD; 0.61, 0.63, and 0.68 for SBP-CV; 0.56, 0.55, and 0.56 for SBP-TTR; and 0.55, 0.56, and 0.58 for SBP-FIR; respectively. AUCs of SBP-SD were significantly larger than those of baseline SBP for thromboembolism (P=0.006) and major hemorrhage (P=0.017), SBP-end for major hemorrhage (P=0.012), SBP-TTR for major hemorrhage (P=0.010) and all-cause death (P=0.015), and SBP-FIR for major hemorrhage (P=0.017). AUCs of SBP-CV showed almost same results as of SBP-SD. Conclusions: Among various BP indices, the visit-to-visit BP variability indices such as SBP-SD and SBP-CV had more powerful predictive value for all adverse events than baseline BP and BP consistency indices in patients with NVAF. BP-end had also strong predictive value for thromboembolism and all-cause death, despite an index of single BP measurement.