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Arrhythmia Watch Editorial Staff

Clinical Articles

Higher blood pressure associated with AF in women

More than 34,000 female health professionals participating in the Women’s Health Study were prospectively followed up over 12.4 years for incident atrial fibrillation (AF). There was a highly significant increase in risk across categories of both systolic and diastolic blood pressure.


Participants were 45 years old or more, and they were free of cardiovascular disease, cancer or other major illness at baseline. They were originally included in a study to investigate use of aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer. The final population for this study was 34,221 women (1). Blood pressure was self-reported, and divided into nine categories of systolic blood pressure (SBP) and seven categories of diastolic blood pressure (DBP) for statistical analysis. Reports of incident AF were included in the analysis if confirmed by medical records such as ECG traces.

During follow-up, 644 women had at least one confirmed episode of incident AF. With increasing SBP and DBP, there were increases in risk of incident AF. The adjusted hazard ratio (HR) was 1.16 per 10mmHg increase in SBP and 1.17 per 10mmHg increase in DBP. In a combined model, SBP but not DBP remained a significant predictor of AF (HR 1.17 per 10mmHg increase in SBP [p<0.0001] and 0.98 for DBP [p=0.74]).

Women with high normal SBP at 48 months (130-139 mmHg) were at higher risk of AF (HR 1.40), as were those with SBP 120-129 mmHg (HR 1.34) compared to those with blood pressures below these values. Analyses also suggested that, over time, lowering SBP may be associated with reductions in AF. Thus, tight blood pressure control may help to reduce the burden of AF in women. The risk of AF according to both systolic and diastolic blood pressure was similar for women older and younger than 65 years, and for those who took antihypertensive therapy at baseline and those who did not.

The study findings suggest that individuals with AF may benefit from a lower BP treatment threshold compared to those without AF. In this population, after SBP was taken into account, a U-shaped relationship emerged between DBP and AF. Elevated pulse pressure and aortic stiffness may play a role in the development of AF in women who are middle-aged and older.


  1. Conen D, Tedrow UB, Koplan BA, Glynn RJ, Buring JE, Albert CM. Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women. Circulation 2009; 119: 2146-52.

Published on: June 7, 2009

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