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Original research article
Ambulatory blood pressure and long-term risk for atrial fibrillation
  1. Valérie Tikhonoff1,
  2. Tatiana Kuznetsova2,
  3. Lutgarde Thijs2,
  4. Nicholas Cauwenberghs2,
  5. Katarzyna Stolarz-Skrzypek3,
  6. Jitka Seidlerová4,
  7. Sofia Malyutina5,
  8. Natasza Gilis-Malinowska6,
  9. Ewa Swierblewska6,
  10. Kalina Kawecka-Jaszcz3,
  11. Jan Filipovský4,
  12. Krzysztof Narkiewicz6,
  13. Gregory Y H Lip7,
  14. Edoardo Casiglia1,
  15. Jan A Staessen2
  16. the European Project On Genes in Hypertension (EPOGH) Investigators
    1. 1 Department of Medicine, University of Padua, Padua, Italy
    2. 2 Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre, University of Leuven, Leuven, Belgium
    3. 3 First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
    4. 4 Faculty of Medicine, Charles University, Pilsen, Czech Republic
    5. 5 Research Institute of Internal and Preventive Medicine – Branch of the Institute of Cytology and Genetics, SB RAS and Novosibirsk State Medical University, Novosibirsk, Russia
    6. 6 Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland
    7. 7 Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
    1. Correspondence to Dr Tatiana Kuznetsova, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven 3000, Belgium; tatiana.kouznetsova{at}


    Objective Data on the contribution of ambulatory blood pressure (ABP) components to the risk of developing atrial fibrillation (AF) are limited. We prospectively tested the hypothesis that ABP may represent a potentially modifiable risk factor for the development of AF in a European population study.

    Methods We recorded daytime blood pressure (BP) in 3956 subjects randomly recruited from the general population in five European countries. Of these participants, 2776 (70.2%) underwent complete 24-hour ABP monitoring. Median follow-up was 14 years. We defined daytime systolic BP load as the percentage BP readings above 135 mm Hg. The incidence of AF was assessed from ECGs obtained at baseline and follow-up and from records held by general practitioners and/or hospitals.

    Results Overall, during 58 810 person-years of follow-up, 143 participants experienced new-onset AF. In adjusted Cox models, each SD increase in baseline 24 hours, daytime and night-time systolic BP was associated with a 27% (P=0.0056), 22% (P=0.023) and 20% (P=0.029) increase in the risk for incident AF, respectively. Conventional systolic BP was borderline associated with the risk of AF (18%; P=0.06). As compared with the average population risk, participants in the lower quartile of daytime systolic BP load (<3%) had a 51% (P=0.0038) lower hazard for incident AF, whereas in the upper quartile (>38%), the risk was 46% higher (P=0.0094).

    Conclusions Systolic ABP is a significant predictor of incident AF in a population-based cohort. We also observed that participants with a daytime systolic BP load >38% had significantly increased risk of incident AF.

    • ambulatory blood pressure
    • atrial fibrillation
    • incidence
    • daytime systolic pressure load
    • longitudinal studies
    • population

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    • VT and TK contributed equally.

    • Contributors KK-J, EC and JAS planned and coordinated the EPOGH and FLEMENGHO projects. VT, TK and LT constructed the database and did the statistical analyses. Responsibility for the integrity of the local datasets rests with: VT and EC (Mirano, Italy); TK, LT, NC and JAS (Noorderkempen, Belgium); KS-S and KK-J (Niepolomice, Poland); JS and JF (Pilsen, Czech Republic); TK and SM (Novosibirsk, Russia); and NG-M, ES and KN (Gdansk, Poland). VT, TK, LT GYHL and JAS wrote the first draft of the paper. All authors interpreted the results and approved the final version of the manuscript.

    • Funding The European Union (grants IC15-CT98-0329-EPOGH, LSHM-CT-2006-037093, HEALTH-F4-2007-201550, HEALTH-2011-278249-EU-MASCARA, ERC Advanced Grant-2011-294713-EPLORE, HEALTH-F7-305507 HOMAGE and PoC Grant 713601-uPROPHET) supported the Studies Coordinating Centre (Leuven, Belgium) and the studies in Kraków, Mirano and Novosibirsk. The Studies Coordinating Centre also received grants from the Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium (grants G.0880.13 and G.0881.13).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study complies with the Declaration of Helsinki. Each local Institutional Review Board approved the study protocol. All subjects provided informed consent in writing.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Belgium (Leuven) – T Kuznetsova, JA Staessen, L Thijs; Czech Republic (Pilsen and Prague) –J Filipovský, Z Marecková, J Peleška, J Seidlerová; Italy (Padua) – E Casiglia and V Tikhonoff; Poland (Kraków) – M Cwynar, J Gąsowski, T Grodzicki, K Kawecka-Jaszcz, M Kloch-Badełek, A Olszanecka, K Stolarz-Skrzypek, B Wizner, W Wojciechowska; (Gdansk) – N Gilis-Malinowska, K Kunicka, K Narkiewicz, W Sakiewicz, E Swierblewska and M Wójtowicz; Russian Federation (Novosibirsk) – T Kuznetsova, S Malyutina, Y Nikitin, A Ryabikov, and M Voevoda. Project coordinator: JA Staessen. Scientific coordinator: K Kawecka-Jaszcz. Echocardiographic study coordinator: T Kuznetsova. Steering committee: E Casiglia, J Filipovsky, K Kawecka-Jaszcz, Y Nikitin, JA Staessen. Data management committee: T Kuznetsova, JA Staessen, K Stolarz-Skrzypek, L Thijs, V Tikhonoff. Publication committee: E Casiglia, K Kawecka-Jaszcz, Y Nikitin.

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