Normal Blood Pressure, High Normal Blood Pressure, and Risk of Incident Atrial Fibrillation: A Population-Based Cohort Study

Background and Aims

This study aimed to investigate the association between normal BP, (blood pressure [BP] 120–129/80–84 mmHg), and high normal BP, (BP 130–139/85–89 mmHg), compared to optimal BP, and risk of atrial fibrillation (AF).

Methods

A population-based cohort study was performed including inhabitants of Västerbotten County, Sweden, aged 30–60 years without AF at inclusion who participated in health examinations in 1988–2014. Approximately 40% of participants had ≥ 2 health examinations. The health examination included a questionnaire and measurement of BP, weight, height, and glucose. Cox regression with time-updated covariates was used to estimate the association between BP and AF risk. Restricted cubic spline analyses were performed.

Results

The cohort included 109,697 persons with 162,982 observations and a mean follow-up of 13.6 years. Incident AF was diagnosed in 5260 participants. We found an increased risk of incident AF associated with normal BP (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.01–1.27) and high normal BP (HR 1.23, 95% CI 1.10–1.38) compared to optimal BP after multivariable adjustment. Systolic BP and diastolic BP in 10 mmHg increments were associated with risk of incident AF, with HRs of 1.11 (95% CI 1.10–1.13) and 1.13 (95% CI 1.09–1.16), respectively, in multivariable models. A restricted cubic spline analysis indicated that the AF risk increased gradually with increasing systolic and diastolic BP.

Conclusion

Individuals with both normal BP and high normal BP have an increased risk of developing incident AF. The risk of AF increased gradually with increasing systolic and diastolic BP.