The Usefulness Of 24-hour Blood Pressure Monitoring For The Patients With Atrial Fibrillation

Background:The measurement and management of blood pressure in patients with atrial fibrillation(AF)have important clinical significance.However,due to the impact of irregular heart rhythm and stroke volume that changed with heart rhythm on blood pressure measurement,the accuracy of the oscillometric blood pressure measurement method in AF patients is currently controversial.ABPM currently uses oscillometric blood pressure measurement.Therefore,the application of ABPM in patients with atrial fibrillation is questionable.The aim of this study was to test whether ABPM in AF patients is reliable as in similar systolic blood pressure(SBP)patients with sinus rhythm(SR)by comparing the blood pressure variability.Methods:This study enrolled 92 inpatients with persistent atrial fibrillation and 92 matched inpatients with sinus rhythm as control group.These patients hospitalized in the Second Affiliated Hospital of Nanchang from September 2018 to January 2019.Their age,gender and SBP levels were matched.The participants were examined simultaneously with 24-hour ABPM and 24-hour Holter electrocardiography.The clinical characteristic,biochemical test results,mean 24-hour(24-hour-),daytime(day-)and nighttime(night-)BP,types of BP curve,morning systolic blood pressure surge(MBPS),the SD of BP readings,the coefficient of variability and heart rate were compared between atrial fibrillation and sinus rhythm patients.All data were analyzed by using the excel 2019 and Statistical Package for Science Software 23.0.The results are presented as mean ± SD for continuous variables,unpaired t-test were used to compare continuous variables between the AF group and the SR group.Categorical variables are expressed as percentages and nonparametric tests are used to compare differences between groups.P value less than 0.05 considered Statistical significance.Results:1.A total of 184 hospitalized patients were included in the study,of which 92 were in the persistent atrial fibrillation group,50% females,and the average age was70.49 ± 11.56 years;92 patients in the sinus rhythm group,46% females,and the average age was 69.23 ± 12.63 years old.2.The clinical characteristics including age,distribution of gender,smoker,drinkers and hypertensives,as well as the levels of triglyceride,total cholesterol,low-density lipoprotein,high-density lipoprotein,glucose glycosylated Hemoglobin and homocysteine were similar between the atrial fibrillation group and the sinus rhythm group.However,the 24-hour mean HR in the atrial fibrillation group was significantly higher than that in the sinus rhythm group,and the difference was statistically significant(77.35 ± 17.38 vs.70.30 ± 10.83 bpm,P <0.001).Meanwhile,the usage of drugs was higher in AF patients than SR patients,and the difference was statistically significant(1.52 ± 0.68 vs.1.18 ± 0.66 bpm,P <0.001),as AF patients often took antiarrhythmic treatment(beta-blockers)and anticoagulation(warfarin).3.No differences of 24-hour-,day-and night-SBP levels were observed between two groups.Meanwhile,the standard deviation(SD)of 24-hour-,day-and night-SBP as well as the coefficient of variability for SBP were also similar between AF patients and SR patients,and there is no statistical difference between the two groups.Furthermore,no significant difference on the MBPS levels and the patients number with high MBPS between the two groups.4.On diastolic BP(DBP),24-hour-and day-levels,the 24-hour-SD and day-SD as well as the coefficient of variability were similar between AF patients and SR patients.But the nighttime DBP levels was higher in the atrial fibrillation group than in the sinus rhythm group,and the difference between two groups was statistically significant(72.39 ± 12.74 bpm vs.67.53 ± 11.27 bpm,P = 0.01).At the same time,the difference of nighttime SD of DBP between AF group and SR group was also statistically significant(9.28 ± 3.01 bpm vs 8.35 ± 2.80 bpm,P = 0.03).5.In AF group,there were 77 cases of nondipper type,6 cases of reverse-dippers type,9 cases of dipper type;In SR group,there were 74 cases of nondipper type,8cases of reverse-dippers type,and 25 cases of dipper type.There was no overdippertype in both groups,and there was no statistical difference in the distribution of blood pressure circadian rhythms between the two groups(P> 0.05).Conclusion:1.ABPM provides data with similar SBP variability in patients with atrial fibrillation as in subject with normal cardiac rhythm,who had similar age,gender distribution and 24-hour-BP levels.2.The ABPM with oscillometric method may be suitable for evaluating the SBP.