Wang Jue, Lv Wenhe, Wang Zhen, Li Sitong, Wang Zhixian, Zhou Le, Wang Yufeng, Ren Lan, Jiang Chao, He Liu, Xia Shijun, Kong Xiangyi, Zuo Song, Kong Yu, Guo Xueyuan, Liu Xiaoxia, Li Songnan, Tang Ribo, Long Deyong, Sang Caihua, Zhou Ning, Du Xin, Dong Jianzeng, Ma Changsheng
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Heart Health Research Center, Beijing, China.
J Clin Hypertens (Greenwich). 2025 Aug;27(8):e70122. doi: 10.1111/jch.70122.
Exaggerated orthostatic changes in systolic blood pressure (SBP) were associated with adverse cardiovascular events. We aim to assess the association between orthostatic SBP changes and incident atrial fibrillation (AF). We performed a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial). Orthostatic SBP changes were defined as standing SBP minus seated SBP. Patients were grouped into tertiles of orthostatic SBP changes. We used Cox proportional regression models to assess the association of orthostatic SBP changes with incident AF. Among 8455 participants included in this analysis, 327 incident AF cases occurred during follow-up. After adjusting for age, female, race, smoking, alcohol use, history of cardiovascular disease, history of chronic kidney disease, and body mass index, an SBP increase ≥6 mmHg to standing was independently associated with a 43% higher risk of incident AF (HR: 1.43; 95% CI: 1.07-1.90; p = 0.014) compared to nonsignificant orthostatic SBP changes (>-4 to <6 mmHg). A SBP decrease ≥4 mmHg to standing showed a nonsignificant higher risk of developing AF compared to SBP changes of >-4 to <6 mmHg. In subgroup analysis, the results presented a similar tendency to the main result. Sensitivity analyses also generated consistent results while additionally adjusting for seated and standing blood pressure or heart rate. In this post hoc analysis of the SPRINT trial, exaggerated SBP increase on standing independently predicts incident AF. Trial Registration: ClinicalTrials.gov identifier: NCT00000620.
收缩压（SBP）的体位性变化过大与不良心血管事件相关。我们旨在评估体位性SBP变化与房颤（AF）发生之间的关联。我们对收缩压干预试验（SPRINT）进行了事后分析。体位性SBP变化定义为站立时SBP减去坐位时SBP。患者按体位性SBP变化三分位数分组。我们使用Cox比例回归模型评估体位性SBP变化与房颤发生之间的关联。在纳入该分析的8455名参与者中，随访期间发生了327例房颤病例。在调整年龄、女性、种族、吸烟、饮酒、心血管疾病史、慢性肾病史和体重指数后，与体位性SBP变化不显著（>-4至<6 mmHg）相比，站立时SBP升高≥6 mmHg与房颤发生风险独立相关，风险高出43%（HR：1.43；95%CI：1.07-1.90；p = 0.014）。与SBP变化>-4至<6 mmHg相比，站立时SBP降低≥4 mmHg显示房颤发生风险较高但无统计学意义。在亚组分析中，结果与主要结果呈现相似趋势。敏感性分析在额外调整坐位和站立位血压或心率时也产生了一致的结果。在SPRINT试验的这项事后分析中，站立时SBP过度升高独立预测房颤发生。试验注册：ClinicalTrials.gov标识符：NCT00000620。
