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Clinical Relevance of Orthostatic Hypotension in Patients with Atrial Fibrillation and Suspected Transient Ischemic Attack

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Abstract

Introduction

Orthostatic hypotension (OH) and atrial fibrillation (AF) are both regarded as independent risk factors for transient ischemic attack (TIA). However, the clinical implication of OH in the presence of AF is unclear. This study investigates, for the first time, the association between blood pressure (BP), OH and mortality in a cohort of patients with AF and TIA symptoms.

Aim

To investigate the incidence of the association between OH, AF and TIA.

Methods

This retrospective observational study utilised the Leicester one-stop transient TIA clinic patient database to consider the initial systolic and diastolic BP of 688 patients with a diagnosis of AF. The primary outcome was time until death. Covariant measures included status of AF diagnosis (known or new AF), cardiovascular risk factors, and primary clinic diagnosis [cerebrovascular (CV) versus non-cerebrovascular (non-CV)]. Statistical models adjusted for sex, age, previous AF diagnosis.

Results

Mortality rate was higher in the over 85 age group [191.5 deaths per 1000 person years (py) (95% CI 154.0–238.1)] and lower in the aged 75 and younger age group [40.0 deaths per 1000 py (95% CI 27.0–59.2)] compared to intermediate groups. A 10 mmHg increase in supine diastolic BP was associated with a significant reduction in the hazard of mortality for patients suspected of TIA with AF [adjusted HR 0.79 (95% CI 0.68–0.92), p < 0.001]. The mortality rate for patients with OH was 119.0 deaths per 1000 py compared with a rate of 98.0 for patients without OH (rate ratio 1.2, p = 0.275).

Conclusion

Higher diastolic BP may be a marker for reduced mortality risk in patients with a previous AF diagnosis and non-CV diagnosis. Lower diastolic BP and the presence of AF pertain to a higher mortality risk. This study raises the importance of opportunistic screening for both OH and AF in patients presenting to TIA clinic.

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Funding

This work was supported by a Collaborations for Leadership in Applied Health Research and Care Phase V Grant (East Midlands). JSM is an NIHR Clinical Lecturer at the Department of Cardiovascular Sciences, University of Leicester. Professor TG Robinson is a National Institute for Health Research Senior Investigator. The funders stated above did not have any involvement in the design, conduct, reporting or decision to submit for publication.

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Authors and Affiliations

  1. Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, Sir Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, LE2 7LX, UK

    Alex S. Mankoo, Jatinder S. Minhas & Thompson G. Robinson

  2. National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK

    Jatinder S. Minhas & Thompson G. Robinson

  3. Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK

    Briana Coles & Kamlesh Khunti

  4. University Hospitals of Leicester NHS Trust, Leicester, UK

    Shazia T. Hussain, Amit K. Mistri & David J. Eveson

  5. National Institute for Health Research, Collaboration for Leadership in Applied Health Research and Care, East Midlands, United Kingdom

    Kamlesh Khunti

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  1. Alex S. Mankoo
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  2. Jatinder S. Minhas
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  6. Thompson G. Robinson
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Correspondence to Thompson G. Robinson.

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Joint Senior Authors: Amit K. Mistri, David J. Eveson.

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Mankoo, A.S., Minhas, J.S., Coles, B. et al. Clinical Relevance of Orthostatic Hypotension in Patients with Atrial Fibrillation and Suspected Transient Ischemic Attack. High Blood Press Cardiovasc Prev 27, 93–101 (2020). https://doi.org/10.1007/s40292-020-00363-4

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