Blood pressure and the risk of stroke in young patients with atrial fibrillation.

BACKGROUND

Elevated blood pressure (BP) levels are associated with a higher risk of stroke in patients with atrial fibrillation (AF). However, limited data exist regarding the effect of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) on ischemic stroke risk in young patients with AF.

OBJECTIVE

This study aimed to evaluate the association between BP levels and incident ischemic stroke in young adults with AF.

METHODS

Using the Korean Health Insurance Service database, we identified patients aged 20-39 years, newly diagnosed with AF between January 2009 and December 2016. The primary outcome was incident ischemic stroke.

RESULTS

A total of 15,980 patients (mean age 32.4 ± 4.8 years, 66.9% men) were included. Mean CHA2DS2-VASc score was 0.7 ± 0.8 and oral anticoagulation rate was 5.6%. During a median 5.2 years (interquartile range 3.1-7.3) of follow-up, 73 patients had incident ischemic stroke (incidence rate 0.9 per 1000 person-years). After multivariable adjustments, SBP 140-159 mmHg and ≥160 mmHg were associated with higher risks of ischemic stroke compared with SBP <100 mmHg (hazard ratios [HRs] 8.39 [95% confidence interval [CI] 1.02-68.73] and 11.59 [1.14-118.05], respectively). Compared with DBP <65 mmHg, DBP ≥95 mmHg was associated with higher risk of ischemic stroke, with HR 4.18 [95% CI 1.26-13.87]. Those with PP <30, 50-59, and ≥60 mmHg were associated with higher risks of ischemic stroke compared with patients with PP 40-49 mmHg (HRs 3.96 [95% CI 1.36-11.53], 1.82 [1.04-3.18], and 3.15 [1.49-6.64], respectively).

CONCLUSION

For young patients aged 20-39 years diagnosed with AF, elevated SBP, DBP, and extreme PP are associated with increased risks of ischemic stroke.