Impact of baseline blood pressure on all-cause mortality in patients with atrial fibrillation:results from a multicenter registry study

Background:The ideal blood pressure(BP)target for patients with atrial fibrillation(AF)is still unclear.The present study aimed to assess the effect of the baseline BP on all-cause mortality in patients with AF.Methods:This registry study included 20 emergency centers across China and consecutively enrolled patients with AF from 2008 to 2011.All participants were followed for 1 year±1 month.The primary endpoint was all-cause mortality.Results:During the follow-up,276(13.9%)all-cause deaths occurred.Kaplan-Meier curves showed that a systolic blood pressure(SBP)110 mmHg or>160 mmHg was associated with a higher risk of all-cause mortality(log-rank test,P=0.014),and a diastolic blood pressure(DBP)<70 mmHg was associated with the highest risk of all-cause mortality(log-rank test,P=0.002).After adjusting for confounders,the multivariable Cox regression model suggested that the risk of all-cause mortality was increased in the group with SBP110 mmHg(hazard ratio[HR],1.963;95%confidence interval[CI],1.306-2.951),and DBP<70 mmHg(HR,1.628;95%CI,1.163-2.281).In the restricted cubic splines,relations between baseline SBP or DBP and all-cause mortality showed J-shaped associations(non-linear P<0.001 and P=0.010,respectively).The risk of all-cause mortality notably increased at a lower baseline SBP and DBP.Conclusions:Having a baseline SBP110 mmHg or DBP<70 mmHg was associated with a significantly higher risk of all-cause mortality in patients with AF.An excessively low BP may not be an optimal target for patients with AF.

Severity of non-alcoholic fatty liver disease is a risk factor for developing hypertension from prehypertension

Background:There is little published evidence about the role of non-alcoholic fatty liver disease(NAFLD)in the progression from prehypertension to hypertension.This study was conducted to investigate the association of NAFLD and its severity with the risk of hypertension developing from prehypertension.Methods:The study cohort comprised 25,433 participants from the Kailuan study with prehypertension at baseline;those with excessive alcohol consumption and other liver diseases were excluded.NAFLD was diagnosed by ultrasonography and stratified as mild,moderate,or severe.Univariable and multivariable Cox proportional hazard regression was used to calculate the hazard ratios(HRs)and 95%confidence intervals(CIs)of incident hypertension according to the presence and 3 categories of severity of NAFLD.Results:During a median of 12.6 years of follow-up,10,638 participants progressed to hypertension from prehypertension.After adjusting for multiple risk factors,patients with prehypertension and NAFLD had a 15%higher risk of incident hypertension than those without NAFLD(HR=1.15,95%CI 1.10-1.21).Moreover,the severity of NAFLD was associated with the incidence of hypertension,which was higher in patients with more severe NAFLD(HR=1.15[95%CI 1.10-1.21]in the mild NAFLD group;HR=1.15[95%CI 1.07-1.24]in the moderate NAFLD group;and HR=1.20[95%CI 1.03-1.41]in the severe NAFLD group).Subgroup analysis indicated that age and baseline systolic blood pressure may modify this association.Conclusions:NAFLD is an independent risk factor for hypertension in patients with prehypertension.The risk of incident hypertension increases with the severity of NAFLD.