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Blood Pressure and Brain Lesions in Patients With Atrial Fibrillation

2020; Lippincott Williams & Wilkins; Volume: 77; Issue: 2 Linguagem: Inglês

10.1161/hypertensionaha.120.16025

1524-4563

Stefanie Aeschbacher, Steffen Blum, Pascal Meyre, Michael Coslovsky, Annina S. Vischer, Tim Sinnecker, Nicolas Rodondi, Jürg H. Beer, Giorgio Moschovitis, Elisavet Moutzouri, Christof Hunkeler, Thilo Burkard, Ceylan Eken, Laurent Roten, Christine S. Zuern, Christian Sticherling, Jens Wuerfel, Leo H. Bonati, David Conen, Stefan Osswald, Michael Kühne, Chloé Auberson, Selinda Ceylan, Simone Doerpfeld, Marc Girod, Elisa Hennings, Philipp Krisai, Andreas U. Monsch, Christian Müller, Anne Springer, Gian Voellmin, Drahomir Aujesky, Urs Fischer, Juerg Fuhrer, Simon Jung, Heinrich P. Mattle, Luise Adam, Carole E. Aubert, Martin Feller, Axel Loewe, Claudio Schneider, Tanja Flückiger, Cindy Groen, Lukas Ehrsam, Sven Hellrigl, Alexandra Nuoffer, Damiana Rakovic, Nathalie Schwab, Rylana Wenger, A. Müller, Christopher Beynon, Roger Dillier, Michèle Deubelbeiss, Franz R. Eberli, C Franzini, Isabel Juchli, Claudia Liedtke, Jacqueline Nadler, Thayze Obst, Jasmin Roth, Fiona Schlomowitsch, Xiaoye Schneider, Katrin Studerus, Noreen Tynan, Dominik Weishaupt, Simone Fontana, Silke Küest, Karin Scheuch, Denise Hischier, Nicole R. Bonetti, Alexandra Grau, Jonas Villinger, Eva Laube, Philipp Baumgartner, Mark G. Filipovic, Marcel Frick, Giulia Montrasio, S. Leuenberger, Franziska Rutz, Tiziano Moccetti, Angelo Auricchio, Adriana Anesini, Cristina Camporini, Giulio Conte, Maria Luce Caputo, François Regoli, Peter Ammann, Roman Brenner, David Altmann, Michaela Gemperle, Daniel Hayoz, Mathieu Firmann, Sandrine Foucras, Martine Rime, Richard Kobza, Benjamin Berte, Virgina Justi, Frauke Kellner‐Weldon, Brigitta Mehmann, Sonja Meier, Myriam Roth, Andrea Ruckli-Kaeppeli, Ian Russi, Kai Schmidt, Mabelle Young, Melanie Zbinden, Jane Frangi-Kultalahti, Anica Pin, Dipen Shah, Georg Ehret, Hervé Gallet, Elise Guillermet, François Lazeyras, Karl‐Olof Lövblad, Patrick Perret, Philippe Tavel, Cheryl Terés, Jürg Schläpfer, Nathalie Lauriers, Marie Méan, Sandrine Salzmann, Frank‐Peter Stephan, Andrea Grêt, Ján Novák, Sandra Vitelli, Marcello Di Valentino, Jane Frangi-Kultalahti, Augusto Gallino, Fabienne Witassek, Matthias Schwenkglenks, Anna Altermatt, Michael Amann, P Huber, Esther Ruberte, Vanessa Zuber, Pascal Benkert, Gilles Dutilh, Milica Marković, Pia Neuschwander, Patrick Simon, Ramun Schmid,

Cardiac Imaging and Diagnostics

The association of blood pressure (BP) and hypertension with the presence of different types of brain lesions in patients with atrial fibrillation is unclear. BP values were obtained in a multicenter cohort of patients with atrial fibrillation. Systolic and diastolic BP was categorized in predefined groups. All patients underwent brain magnetic resonance imaging and neurocognitive testing. Brain lesions were classified as large noncortical or cortical infarcts, small noncortical infarcts, microbleeds, or white matter lesions. White matter lesions were graded according to the Fazekas scale. Overall, 1738 patients with atrial fibrillation were enrolled in this cross-sectional analysis (mean age, 73 years, 73% males). Mean BP was 135/79 mm Hg, and 67% of participants were taking BP-lowering treatment. White matter lesions Fazekas ≥2 were found in 54%, large noncortical or cortical infarcts in 22%, small noncortical infarcts in 21%, and microbleeds in 22% of patients, respectively. Compared with patients with systolic BP <120 mm Hg, the adjusted odds ratios (95% CI) for Fazekas≥2 was 1.25 (0.94-1.66), 1.41 (1.03-1.93), and 2.54 (1.65-3.95) among patients with systolic BP of 120 to 140, 140 to 160, and ≥160 mm Hg (P for linear trend<0.001). Per 5 mm Hg increase in systolic and diastolic BP, the adjusted β-coefficient (95% CI) for log-transformed white matter lesions was 0.04 (0.02-0.05), P<0.001 and 0.04 (0.01-0.06), P=0.004. Systolic BP was associated with small noncortical infarcts (odds ratios [95% CI] per 5 mm Hg 1.05 [1.01-1.08], P=0.006), microbleeds were associated with hypertension, but large noncortical or cortical infarcts were not associated with BP or hypertension. After multivariable adjustment, BP and hypertension were not associated with neurocognitive function. Among patients with atrial fibrillation, BP is strongly associated with the presence and extent of white matter lesions, but there is no association with large noncortical or cortical infarcts. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02105844.