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

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journal contribution
posted on 26.03.2020, 08:56 by Alex S Mankoo, Jatinder S Minhas, Briana Coles, Shazia T Hussain, Kamlesh Khunti, Thompson G Robinson, Amit K Mistri, David J Eveson, LeiSTAR Steering Committee
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.

History

Citation

High Blood Press Cardiovasc Prev 27, 93–101 (2020). https://doi.org/10.1007/s40292-020-00363-4

Author affiliation

Department of Cardiovascular Sciences

Version

AM (Accepted Manuscript)

Published in

High Blood Pressure and Cardiovascular Prevention

Volume

27

Issue

1

Pagination

93 - 101

Publisher

Springer Science and Business Media LLC

issn

1120-9879

eissn

1179-1985

Acceptance date

23/01/2020

Copyright date

2020

Publisher version

https://link.springer.com/article/10.1007/s40292-020-00363-4

Spatial coverage

New Zealand

Language

eng