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PROGNOSTIC VALUE OF OFFICE BLOOD PRESSURE MEASUREMENT AND HYPERTENSION DIAGNOSIS IN ATRIAL FIBRILLATION: SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: In the presence of atrial fibrillation (AF) cuff-based blood pressure measurement is uncertain. Thus, AF patients have been systematically excluded from hypertension outcome trials. A meta-analysis of prospective outcome trials in AF patients on oral anticoagulants was performed, aiming to evaluate the prognostic significance of office blood pressure (OBP) measurements and hypertension diagnosis. Design and method: A systematic PubMed search was performed as follows: (((’atrial fibrillation’) AND (’blood pressure’ OR hypertension)) AND anticoagula*) AND (stroke OR embolism OR thromboembolism OR outcome OR ’cardiovascular events’). Articles were also identified from reference lists of relevant papers and hand search. Prospective studies with at least 50% of AF patients on oral anticoagulant therapy were included. Results: The meta-analysis included 8 studies (n = 73,930) in which 53% (1 study) to 100% (5 studies) of participants received anticoagulants. There was considerable heterogeneity in the OBP methodology, which was not standardized in most studies. Four studies reported on the prognostic value of baseline OBP and/or history of hypertension diagnosis, 2 on the average OBP control during follow-up, and 2 on both baseline and follow-up OBP control. Meta-analysis of 6 studies (5 studies used baseline OBP/hypertension diagnosis; 69,018 subjects; 130,943 person-years) showed elevated OBP and/or hypertension diagnosis to predict stroke or systemic embolism (hazard ratio [HR] 1.28; 95% confidence intervals [CI] 1.12, 1.45). Meta-analysis of 7 studies (n = 69,983) showed elevated OBP and/or hypertension diagnosis not to predict major haemorrhage (HR 1.11; CI 0.98, 1.25). Meta-analysis of 3 studies (n = 29,477) showed that follow-up OBP control strongly predicted stroke or systemic embolism (HR 1.79; CI 1.38, 2.32) (z-score -2.3, p < 0.05 versus HR of 6 studies), but not major haemorrhage (HR 1.13, CI 0.95, 1.35). OBP and/or hypertension diagnosis did not predict all-cause mortality (7 studies; n = 66,524; HR 1.07; CI 0.91, 1.26). Conclusions: Outcome studies suggest that in AF patients, OBP and hypertension diagnosis predict stroke or systemic embolism, but not major haemorrhage or all-cause mortality. Follow-up OBP control appears to have stronger predictive ability than baseline OBP and/or hypertension diagnosis.