Day-to-day home blood pressure variability and risk of atrial fibrillation in a general Japanese population: the Hisayama Study.

ABSTRACT

AIMS: Several prospective studies have reported that higher visit-to-visit blood pressure variability (BPV) is associated with atrial fibrillation (AF). However, no studies have investigated the association between day-to-day BPV assessed by home blood pressure measurement and the development of AF. METHODS AND RESULTS: A total of 2829 community-dwelling Japanese aged ≥40 years without prior AF were followed up for 10 years (2007-17). Day-to-day home BPV [defined as coefficient of variation (CoV) of home systolic blood pressure (SBP) for 28 days] was categorized into four groups according to the quartiles Q1, ≤ 4.64%; Q2, 4.65-5.70%; Q3, 5.71-7.01%; Q4, ≥ 7.02%. The hazard ratios for developing AF were estimated using a Cox proportional hazards model. During the follow-up period, 134 participants developed new-onset AF. The crude incidence rates of AF increased significantly with higher CoV levels of home SBP 2.1, 4.9, 5.2, and 8.8 per 1000 person-years in the first, second, third, and fourth quartiles, respectively (P for trend < 0.01). After adjusting for potential confounders, increased CoV levels of home SBP were associated significantly with a higher risk of AF (P for trend = 0.02). The participants in the highest quartile of CoV had a 2.20-fold (95% confidence intervals 1.18-4.08) increased risk of developing AF compared with those in the lowest quartile. CONCLUSION: The present findings suggest that increased day-to-day home BPV levels are associated with a higher risk of the development of AF in a general Japanese population.

This prospective cohort study of a general Japanese population demonstrated a significant association between higher day-to-day blood pressure variability (BPV) assessed by home blood pressure monitoring and risk for the development of atrial fibrillation (AF). In addition, the association between BPV and the development of AF tended to be stronger in participants without hypertension. The findings of this study indicate that the evaluation of day-to-day BPV with home blood pressure monitoring may be useful to assess the future risk of AF in participants with and without hypertension, and treatment that takes into account day-to-day BPV in addition to other cardiovascular risk factors may be necessary to prevent the development of AF.