Time-averaged cumulative pulse pressure in midlife and incident atrial fibrillation: the atherosclerosis risk in communities study.

While elevated arterial stiffness is recognized as a predictor of atrial fibrillation (AF), the relationship between long-term pulse pressure (PP) and the incidence of AF remains to be fully elucidated. We assessed the influence of time-averaged cumulative PP in midlife on incident AF. The analysis included 9150 adults from the Atherosclerosis Risk in Communities (ARIC) cohort who were free of AF at visit 4. The time-averaged cumulative blood pressure (BP) was calculated as the sum of the averaged BPs from the adjacent consecutive visits (visits 1-4), with the values being indexed to the total exposure time. At visit 4, the mean age of the study population was 62.9 years, with 4045 (44.2%) of the population being male. In 1455 individuals (15.9%) with a median follow-up of 16 years, incident AF was seen. The greatest predictor of incident AF, as indicated by the decline in the -2 Log likelihood statistic, was time-averaged cumulative PP, which was linked to an elevated risk for AF (HR = 1.20 (1.13-1.27)) in adjusted Cox models (per 1-SD increment). The correlation between incident AF and time-averaged cumulative systolic blood pressure (SBP) was 1.14 (1.07-1.22). In contrast, the diastolic relation tended to be opposite (HR = 0.94 (0.88-1.00)). Moreover, among persons aged < 65 years, without hypertension or antihypertensive treatment, these associations were even more remarkable (P < 0.05 for all interactions). Time-averaged cumulative PP in midlife was an important risk factor for incident AF with the strongest predictive effect, especially in persons who were younger, normotensive, or without antihypertensive treatment.