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. 2025 Apr 7;46(14):1291-1300.
doi: 10.1093/eurheartj/ehaf005.

Long-term pulse pressure trajectories and risk of incident atrial fibrillation: the Tromsø Study

Ekaterina Sharashova  1   2 , Eva Gerdts  3 , Jocasta Ball  4 , Renate B Schnabel  5   6 , Michael Stylidis  2 , Sweta Tiwari  7   8 , Ellisiv B Mathiesen  7 , Tom Wilsgaard  1 , Maja-Lisa Løchen  7
Affiliations

Long-term pulse pressure trajectories and risk of incident atrial fibrillation: the Tromsø Study

Ekaterina Sharashova et al. Eur Heart J. .

Abstract

Background and aims: Sex-based differences in the association of long-term trends in pulse pressure with future risk of atrial fibrillation (AF) have been explored using data from the population-based Tromsø Study 1986-2016.

Methods: Women (n = 8331) and men (n = 7638) aged ≥20 years who attended at least two of the three Tromsø Study surveys conducted between 1986 and 2001 (the exposure period) were followed up for incident AF throughout 2016 (the follow-up period). Pulse pressure ≥60 mmHg was considered elevated. Group-based trajectory modelling and Cox regression were used for statistical analyses.

Results: Three long-term trajectory groups for pulse pressure were identified: Group 1 had normal pulse pressure throughout the exposure period, Group 2 had normal pulse pressure at the beginning and elevated pulse pressure at the end of the exposure period, and Group 3 had elevated pulse pressure throughout. Over the follow-up period, 568 (6.8%) women and 798 (10.5%) men developed AF. After adjustment for potential confounders at baseline, the long-term trajectory groups for elevated pulse pressure were associated with increased risk of AF in women, but not in men. In women, the adjusted hazard ratios of AF were 1.60 (95% confidence interval: 1.23, 2.09) for trajectory Group 2 and 2.78 (1.93, 4.02) for trajectory Group 3, compared with Group 1.

Conclusions: Long-term elevated pulse pressure trajectories were independently associated with increased risk of AF in women, but not in men. Our findings call for further investigations to understand the mechanisms behind these sex-based differences.

Keywords: Atrial fibrillation; Blood pressure; Epidemiology; Incidence; Pulse pressure; Sex differences; Trajectories.

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Figures

Structured Graphical Abstract
Structured Graphical Abstract
Sex-specific associations between long-term elevated pulse pressure trajectories and the risk of incident atrial fibrillation in the Tromsø Study. Women, but not men, with sustained elevated pulse pressure (≥60 mmHg) showed an increased risk of atrial fibrillation, emphasizing the need for sex-specific strategies to monitor and manage arterial stiffness to prevent atrial fibrillation.
Figure 1
Figure 1
Flowchart of the participants. The Tromsø Study 1986–2016
Figure 2
Figure 2
Long-term trajectory groups for elevated pulse pressure in women and men. The Tromsø Study 1986–2016. Sex-specific proportions of those with elevated pulse pressure (≥60 mmHg) presented according to the three surveys and the three pulse pressure trajectory groups
See this image and copyright information in PMC

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