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Observational Study
. 2020 Feb;27(1):93-101.
doi: 10.1007/s40292-020-00363-4. Epub 2020 Feb 11.

Clinical Relevance of Orthostatic Hypotension in Patients with Atrial Fibrillation and Suspected Transient Ischemic Attack

Alex S Mankoo  1 , Jatinder S Minhas  1   2 , Briana Coles  3 , Shazia T Hussain  4 , Kamlesh Khunti  3   5 , Thompson G Robinson  6   7 , Amit K Mistri  4 , David J Eveson  4 ; LeiSTAR SteeringCommittee
Affiliations
Observational Study

Clinical Relevance of Orthostatic Hypotension in Patients with Atrial Fibrillation and Suspected Transient Ischemic Attack

Alex S Mankoo et al. High Blood Press Cardiovasc Prev. 2020 Feb.

Abstract

Introduction: Orthostatic hypotension (OH) and atrial fibrillation (AF) are both regarded as independent risk factors for transient ischemic attack (TIA). However, the clinical implication of OH in the presence of AF is unclear. This study investigates, for the first time, the association between blood pressure (BP), OH and mortality in a cohort of patients with AF and TIA symptoms.

Aim: To investigate the incidence of the association between OH, AF and TIA.

Methods: This retrospective observational study utilised the Leicester one-stop transient TIA clinic patient database to consider the initial systolic and diastolic BP of 688 patients with a diagnosis of AF. The primary outcome was time until death. Covariant measures included status of AF diagnosis (known or new AF), cardiovascular risk factors, and primary clinic diagnosis [cerebrovascular (CV) versus non-cerebrovascular (non-CV)]. Statistical models adjusted for sex, age, previous AF diagnosis.

Results: Mortality rate was higher in the over 85 age group [191.5 deaths per 1000 person years (py) (95% CI 154.0-238.1)] and lower in the aged 75 and younger age group [40.0 deaths per 1000 py (95% CI 27.0-59.2)] compared to intermediate groups. A 10 mmHg increase in supine diastolic BP was associated with a significant reduction in the hazard of mortality for patients suspected of TIA with AF [adjusted HR 0.79 (95% CI 0.68-0.92), p < 0.001]. The mortality rate for patients with OH was 119.0 deaths per 1000 py compared with a rate of 98.0 for patients without OH (rate ratio 1.2, p = 0.275).

Conclusion: Higher diastolic BP may be a marker for reduced mortality risk in patients with a previous AF diagnosis and non-CV diagnosis. Lower diastolic BP and the presence of AF pertain to a higher mortality risk. This study raises the importance of opportunistic screening for both OH and AF in patients presenting to TIA clinic.

Keywords: Atrial fibrillation; Blood pressure; Orthostatic hypotension; Stroke; Transient ischemic attack.

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References

    1. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors J, Culebras A, Elkind MS, George MG, Hamdan AD, Higashida RT. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:2064–89. - DOI
    1. Cruz-Flores S. Acute stroke and transient ischemic attack in the outpatient clinic. Med Clin N Am. 2017;101:479–94. - DOI
    1. Royal College of Physicians (2014) Sentinel Stroke National Audit Programme (SSNAP): Clinical Audit April–June 2015 Public Report. Royal College of Physicians London.
    1. Cordonnier C, Leys D. Stroke: the bare essentials. Pract Neurol. 2008;8:263–72. - DOI
    1. NICE (2017) Stroke and TIA, secondary prevention following stroke and TIA, NICE guideline CKS. https://cks.nice.org.uk/stroke-and-tia#!scenario:2 . Accessed 05 July 2019.

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