Physicians' Academy for Cardiovascular Education

SBP variability is associated with clinical outcomes in atrial fibrillation patients

Systolic Blood Pressure Visit-to-Visit Variability and Major Adverse Outcomes in Atrial Fibrillation: The AFFIRM Study (Atrial Fibrillation Follow-Up Investigation of Rhythm Management)

Literature - Proietti M, Romiti GF, Olshansky B, et al. - Hypertension 2017, published online ahead of print


Although in the general population, greater BP variability, defined as SBP-visit-to-visit variability (VVV), is related to a higher risk of CV events and death, the clinical impact of SBP-VVV in AF patients is not known [1]. Moreover, no data are available about the relationship between SBP-VVV and quality of anticoagulation control. The latter is a strong predictor of major adverse events in these patients, and is expressed as individual time in therapeutic range (TTR) or percentage of international normalized ratio (INR) in range (PINRR) [2,3].

In this post hoc analysis of the AFFIRM trial, the relationship between SBP-VVV and quality of anticoagulation control was investigated, and the association between SBP-VVV and major adverse clinical outcomes in AF patients was analysed. The AFFIRM trial compared a rate-control versus a rhythm-control strategy for the clinical management of AF patients, with a mean follow-up of 3.5 years [4].

For the current analyses, all patients with available data on SBP at baseline and with at least 4 other measurements during follow-up were selected (n=3843; 94.7% of all AFFIRM patients). SBP-VVV was defined according to the SD of mean SBP during follow-up for every patient. According to the SBP-SD, patients were categorized in quartiles (1stQ: <10.09; 2ndQ: 10.09–13.85; 3rdQ: 13.86–17.33; 4thQ: ≥17.34 mmHg).

The thromboembolic risk was defined according to the CHA2DS2-VASc risk score, and the quality of anticoagulation control was assessed according to TTR and PINRR calculated from INR values. The outcomes of interest were stroke, major bleeding, CV death, all-cause death, and a composite of stroke/major bleeding/CV death.

Main results

SBP-VVV and quality of anticoagulation control

Follow-Up and Survival Analysis

Multivariate Analyses


In the AFFIRM study, SBP-VVV was inversely associated with the quality of anticoagulation control in AF patients, and increasing SBP-VVV was associated with a higher risk of major adverse clinical events. These results suggest that reducing SBP-VVV and improving the quality of anticoagulation control might be of benefit for AF patients.


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