Winston-Salem, NC—The type of intensive blood pressure-control recommended in recent guidelines appears to reduce the risk of atrial fibrillation (AF), according to a new study.

The report in the American Heart Association journal Hypertension advises that lowering systolic blood pressure (BP) to less than 120 resulted in a 26% lower risk of AF compared with systolic BP of less than 140. Controlling AF is important because it can lead to stroke, heart failures, and acute myocardial infarction, according to the Wake Forest School of Medicine researchers.

“This is the first evidence from a randomized controlled trial that showed benefit in reducing the risk of atrial fibrillation as a result of aggressive blood pressure control to a target of less than 120 mm Hg,” explained lead author, Elsayed Z. Soliman, MD, professor of epidemiology and prevention.

The authors note that whether intensive control of BP results in a lower risk of AF in patients with hypertension had been unproven. To provide more information, they used data from the Systolic Blood Pressure Intervention Trial (SPRINT), which enrolled participants with hypertension at increased risk of cardiovascular disease.

The goal was to ascertain whether intensive BP lowering—defined as target systolic BP (SBP) of lower than 120 mm Hg—compared with standard BP lowering—defined as target SBP lower than 140 mm Hg—appears to result in a lower risk of AF.

Included in the analysis were 8,022 participants—4,003 randomized to the intensive arm and 4,019 to standard BP arm—who had not been diagnosed with AF at the time of enrollment and with available baseline and follow-up electrocardiographic data. AF was diagnosed by standard 12-lead electrocardiograms recorded at biannual study examinations and an exit visit.

Over the 5.2 years of follow-up and 28,322 person-years, 206 incident AF cases occurred; 88 of those were in the intensive BP-lowering arm, while 118 were in the standard BP-lowering arm, the researchers report.

Results indicate that intensive BP lowering was associated with a 26% lower risk of developing new AF (hazard ratio, 0.74; 95% CI, 0.56-0.98; P = .037). The authors point out that the effect was consistent among prespecified subgroups of SPRINT participants stratified by age, sex, race, SBP tertiles, prior cardiovascular disease, and prior chronic kidney disease.

“In conclusion, intensive treatment to a target of SBP <120 mm Hg in patients with hypertension at high risk of cardiovascular disease has the potential to reduce the risk of AF,” the authors write.

“Hypertension is the most common modifiable risk factor for atrial fibrillation,” Dr. Soliman added. “And now, we have a potential pathway for prevention.”

Previous SPRINT findings published by Wake Forest Baptist researchers have shown that lowering BP reduces risk of cognitive impairment and may slow age-related brain damage.

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