Blood Pressure and Brain Lesions in Patients With Atrial Fibrillation
Authors: Aeschbacher Stefanie , Blum Steffen , Meyre Pascal B. , Coslovsky Michael , Vischer Annina S. , Sinnecker Tim , Rodondi Nicolas , Beer Jürg H. , Moschovitis Giorgio , Moutzouri Elisavet , Hunkeler Christof , Burkard Thilo , Eken Ceylan , Roten Laurent , Zuern Christine S. , Sticherling Christian , Wuerfel Jens , Bonati Leo H. , Conen David , Osswald Stefan , Kühne Michael , Auberson Chloé , Ceylan Selinda , Doerpfeld Simone , Girod Marc , Hennings Elisa , Krisai Philipp , Monsch Andreas U. , Müller Christian , Springer Anne , Voellmin Gian , Aujesky Drahomir , Fischer Urs , Fuhrer Juerg , Jung Simon , Mattle Heinrich , Adam Luise , Elodie Aubert Carole , Feller Martin , Loewe Axel , Schneider Claudio , Flückiger Tanja , Groen Cindy , Ehrsam Lukas , Hellrigl Sven , Nuoffer Alexandra , Rakovic Damiana , Schwab Nathalie , Wenger Rylana , Müller Andreas , Beynon Christopher , Dillier Roger , Deubelbeiss Michèle , Eberli Franz , Franzini Christine , Juchli Isabel , Liedtke Claudia , Nadler Jacqueline , Obst Thayze , Roth Jasmin , Schlomowitsch Fiona , Schneider Xiaoye , Studerus Katrin , Tynan Noreen , Weishaupt Dominik , Fontana Simone , Kuest Silke , Scheuch Karin , Hischier Denise , Bonetti Nicole , Grau Alexandra , Villinger Jonas , Laube Eva , Baumgartner Philipp , Filipovic Mark , Frick Marcel , Montrasio Giulia , Leuenberger Stefanie , Rutz Franziska , Moccetti Tiziano , Auricchio Angelo , Anesini Adriana , Camporini Cristina , Conte Giulio , Luce Caputo Maria , Regoli Francois , Ammann Peter , Brenner Roman , Altmann David , Gemperle Michaela , Hayoz Daniel , Firmann Mathieu , Foucras Sandrine , Rime Martine , Kobza Richard , Berte Benjamin , Justi Virgina , Kellner-Weldon Frauke , Mehmann Brigitta , Meier Sonja , Roth Myriam , Ruckli-Kaeppeli Andrea , Russi Ian , Schmidt Kai , Young Mabelle , Zbinden Melanie , Frangi-Kultalahti Jane , Pin Anica , Shah Dipen , Ehret Georg , Gallet Hervé , Guillermet Elise , Lazeyras Francois , Lovblad Karl-Olof , Perret Patrick , Tavel Philippe , Teres Cheryl , Schläpfer Jürg , Lauriers Nathalie , Méan Marie , Salzmann Sandrine , Stephan Frank-Peter , Grêt Andrea , Novak Jan , Vitelli Sandra , Di Valentino Marcello , Frangi-Kultalahti Jane , Gallino Augusto , Witassek Fabienne , Schwenkglenks Matthias , Altermatt Anna , Amann Michael , Huber Petra , Ruberte Esther , Zuber Vanessa , Benkert Pascal , Dutilh Gilles , Markovic Milica , Neuschwander Pia , Simon Patrick , Schmid Ramun 
Published: December 2020

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.