Patient-reported triggers of paroxysmal atrial fibrillation can be avoided

A study published in the Journal of Heart Rhythm reported that the most common triggers of atrial fibrillation (AF) are avoidable behaviors like drinking alcohol, coffee consumption and exercise.  

Of 1295 participants with symptomatic AF, 957 (74%) reported triggers for episodes of AF. In comparison to participants without triggers and after multivariate adjustment, those reporting triggers had a 71% lower odds of congestive heart failure and a >2-fold greater odds of a family history of AF.  The most commonly reported triggers were alcohol (35%), caffeine (28%), exercise (23%), and lack of sleep (21%). Patients reported a median of 2 different triggers.  Female sex, Hispanic ethnicity, obstructive sleep apnea, and a family history of AF were each associated with a greater number of AF triggers. Vagal nerve mediated triggers tended to cluster together within individuals.

The authors concluded that the majority of patient-reported triggers are modifiable, thus potentially identifying accessible means to prevent and reduce AF episodes. 

Is one blood pressure measurement enough?

While In the U.S., 116 million adults have high blood pressure, it is estimated in the world nearly 1.5 billion adults will have hypertension in the decade ahead.

Ι analyzed 107 consecutive blood pressure (BP) measurements that were obtained between June 1 and November 20, 2019.  The BP measurements were obtained with an Omron BP-monitor; model BP786N, a device that obtains 3 consecutive measurements at one-minute intervals, which it also averages.   All four measurements were recorded.  

The average BP measurements were grouped in the following four categories; Normal readings were those systolic blood pressure was less than 120mmHg.  Elevated readings were those with systolic blood pressure between 120 and 129mmHg.  Hypertension-1 were those with systolic blood pressure between 130 and 139mmHg and hypertension-2 were those with systolic blood pressure over 140mmHg.   

In the normotensive category with readings under 120mmHg, in 12 of 59 readings or 20.3% the first of the 3 measurements were over 120mmHg.  In those patients treatment will be initiated incorrectly in the U.S.

In the elevated category with readings between 120 and 129mmHg 8 of the 20 measurements or 40%, were over 130mmHg which means treatment will be initiated incorrectly in Europe.

In the hypertension-1 category with readings between 130 and 139mmHg 2 of the 15 readings or 13% were below 130mmHg, which means treatment will not be initiated incorrectly in Europe.

In the hypertension-2 category with average measurements over140mmHg, 12 of 13 readings or 92.3% the first reading was over 140mmHg and 1 measurement was over 130mmHg, which means treatment would have been correctly initiated in 100% of the cases in both the U.S. and Europe.

We conclude both in the U.S. and Europe if the first measurement is over 140mmHg patients should be placed on hypertensive medications.  If the first measurement is less than 139mmHg then 3 measurements should be obtained and treatment or not should be initiated based on the average of 3 blood pressure measurements.