Longitudinal Measures of Blood Pressure and Subclinical Atrial Arrhythmias: The MESA and the ARIC Study

Abstract

Background High blood pressure (BP) is a well-known risk factor for atrial fibrillation (AF), but a single BP measurement may provide limited information about AF risk in older adults. Methods and Results This study included 1256 MESA (Multi-Ethnic Study of Atherosclerosis) and 1948 ARIC (Atherosclerosis Risk in Communities) study participants who underwent extended ambulatory electrocardiographic monitoring and who were free of clinically detected cardiovascular disease, including AF. Using BP measurements from 6 examinations (2000-2018 in MESA and 1987-2017 in ARIC study), we calculated individual long-term mean, trend, and detrended visit-to-visit variability in systolic BP and pulse pressure for each participant. Outcomes, assessed at examination 6, included subclinical AF and supraventricular ectopy. Results from each study were combined with inverse variance-weighted meta-analysis. At examination 6, the mean age was 73 years in MESA and 79 years in ARIC study, and 4% had subclinical AF. Higher visit-to-visit detrended variability in systolic BP was associated with a greater prevalence of subclinical AF (odds ratio [OR], 1.20; 95% CI, 1.02-1.38) and with more premature atrial contractions/hour (geometric mean ratio, 1.08; 95% CI, 1.01-1.15). For pulse pressure as well, higher visit-to-visit detrended variability was associated with a greater prevalence of AF (OR, 1.18; 95% CI, 1.00-1.37). In addition, higher long-term mean pulse pressure was associated with a greater prevalence of subclinical AF (OR, 1.36; 95% CI, 1.08-1.70). Conclusions Antecedent visit-to-visit variability in systolic BP and pulse pressure, but not current BP, is associated with a higher prevalence of subclinical atrial arrhythmias. Prior longitudinal BP assessment, rather than current BP, may be more helpful in identifying older adults who are at higher risk of atrial arrhythmias.

Keywords: arrhythmia; atrial fibrillation; atrial fibrillation arrhythmia; blood pressure; electrocardiography; older adults.

Figure 1. Flowcharts showing inclusion criteria and exclusions for the MESA (Multi‐Ethnic Study of Atherosclerosis) and the ARIC (Atherosclerosis Risk in Communities) study analytic cohorts.

AF indicates atrial fibrillation; BP, blood pressure; CVD, cardiovascular disease; HF, heart failure; and MI, myocardial infarction; and N/A, not applicable.

Figure 2. Method of measuring intraindividual components of blood pressure (BP), including cross‐sectional value, long‐term mean, trend, and visit‐to‐visit variability.

Cross‐sectional BP was assessed at examination 6 (2016–2018 in the MESA [Multi‐Ethnic Study of Atherosclerosis] and 2016–2017 in the ARIC [Atherosclerosis Risk in Communities] study). Long‐term mean BP was calculated over examinations 1 through 5 (in MESA, this included examinations between 2000 and 2011; and in ARIC study, this included examinations between 1987 and 2013). BP trend was calculated as the β coefficient from an individual‐specific linear regression line of the BP values at examinations 1 through 5, with the follow‐up examination date serving as the independent variable. Visit‐to‐visit variability was calculated as the square root of the variance, or the residual mean square, from the 5 residuals of the individual‐specific linear regression.

Figure 3. Meta‐analysis results for associations between systolic blood pressure (SBP) exposure variables and atrial arrhythmias.

AF indicates atrial fibrillation; ARIC, Atherosclerosis Risk in Communities; Exam, examination; ID, identifier; MESA, Multi‐Ethnic Study of Atherosclerosis; PAC, premature atrial contraction; and SVT, supraventricular tachycardia.

Figure 4. Meta‐analysis results for associations between pulse pressure (PP) exposure variables and atrial arrhythmias.

AF indicates atrial fibrillation; ARIC, Atherosclerosis Risk in Communities; Exam, examination; ID, identifier; MESA, Multi‐Ethnic Study of Atherosclerosis; PAC, premature atrial contraction; and SVT, supraventricular tachycardia.