Time in systolic blood pressure target range predicts adverse event risk in NVAF

The time in target rage (TTR) of systolic blood pressure (SBP) appears to be predictive in assessing the risk of cardiovascular death in patients with nonvalvular atrial fibrillation (NVAF), reports a recent study.

Through a post hoc analysis of the J-RHYTHM registry, the researchers evaluated 7,226 NVAF patients (mean age 70 years, 71 percent men) in whom BP had been assessed at least four times over a 2-year follow-up period. The target SBP range was 110–130 mm Hg. TTR was calculated by the Rosendaal linear interpolation method.

Average SBP-TTR was 50 percent. Bumping the target range up to 120–140 mm Hg only slightly altered the resulting TTR, which was 51 percent. Over the follow-up period, thromboembolism occurred in 110 patients, yielding an incidence rate of 1.5 percent. Corresponding rates of major haemorrhage, all-cause death, and cardiovascular death were 1.7 percent, 2.3 percent, and 0.8 percent.

When assessed as a continuous variable, every 1-percent increase in BP-TTR at 110–130 mm Hg suppressed the risk of all adverse events in the crude model. In the fully adjusted analysis, however, only cardiovascular death remained statistically associated with BP-TTR. BP-TTR at 120–140 mm Hg did not correlate with any adverse outcome.

“The present results suggest that systolic BP-TTR of 110–130 mm Hg … irrespective of target systolic BP of <110 or <120 mm Hg, would be useful for risk evaluation of cardiovascular death and thromboembolism, respectively, in patients with NVAF,” the researchers said.