Day-to-day home blood pressure variability and risk of atrial fibrillation in a general Japanese population: the Hisayama Study

Aims Several prospective studies have reported that higher visit-to-visit blood pressure variability (BPV) is associated with atrial fibrillation (AF). However, no studies have investigated the association between day-to-day BPV assessed by home blood pressure measurement and the development of AF. Methods A total of 2829 community-dwelling Japanese aged ≥40 years without prior AF were followed up for 10 years (2007–17). and results Day-to-day home BPV [defined as coefficient of variation (CoV) of home systolic blood pressure (SBP) for 28 days] was categorized into four groups according to the quartiles: Q1, ≤ 4.64%; Q2, 4.65–5.70%; Q3, 5.71–7.01%; Q4, ≥ 7.02%. The hazard ratios for developing AF were estimated using a Cox proportional hazards model. During the follow-up period, 134 participants developed new-onset AF. The crude incidence rates of AF increased significantly with higher CoV levels of home SBP: 2.1, 4.9, 5.2, and 8.8 per 1000 person-years in the first, second, third, and fourth quartiles, respectively (P for trend < 0.01). After adjusting for potential confounders, increased CoV levels of home SBP were associated significantly with a higher risk of AF (P for trend = 0.02). The participants in the highest quartile of CoV had a 2.20-fold (95% confidence intervals: 1.18–4.08) increased risk of developing AF compared with those in the lowest quartile. Conclusion The present findings suggest that increased day-to-day home BPV levels are associated with a higher risk of the development of AF in a general Japanese population. Lay summary_• This prospective cohort study of a general Japanese population demonstrated a significant association between higher day-to-day blood pressure variability (BPV) assessed by home blood pressure monitoring and risk for the development of atrial fibrillation (AF). _• In addition, the association between BPV and the development of AF tended to be stronger in participants without hypertension. _• The findings of this study indicate that the evaluation of day-to-day BPV with home blood pressure monitoring may be useful to assess the future risk of AF in participants with and without hypertension, and treatment that takes into account day-to-day BPV in addition to other cardiovascular risk factors may be necessary to prevent the development of AF.