Supine hypertension as a predictor of atrial fibrillation: a UK biobank cohort study
K Y Lee, T M Rhee, J M Choi, H J Ahn, S R Lee, H S Lee, S Y Choi, S Oh, G Lip, E K ChoiAbstract
Background
Atrial fibrillation (AF) is a common arrhythmia strongly associated with blood pressure (BP), yet most current assessments focus only on seated BP measurements. Supine BP may offer additional predictive value by capturing positional or autonomic variations often missed in standard evaluations.
Purpose
This study is to investigate the association between supine BP and incident AF.
Methods
We analyzed 24,901 UK Biobank participants without prior cardiovascular disease or antihypertensive treatment, categorizing them into four groups based on the presence of seated and/or supine hypertension: normal BP, seated-only hypertension, supine-only hypertension, and both seated- and supine-hypertension. The primary endpoint was incident AF over a median follow-up of 4.5 years.
Results
Among 24,901 participants (mean age 63.1 ± 7.7 years; 44.0% male), supine systolic BP was independently associated with incident AF (aHR 1.12 [95% CI 1.05-1.20] per 10 mmHg increase), while seated systolic BP showed a weaker association. Supine-only hypertension (aHR 1.38 [1.09-1.75]) and both seated- and supine-hypertension (aHR 1.35 [1.01-1.81]) significantly increased AF risk, whereas seated hypertension alone did not. Supine hypertension improved AF risk prediction, increasing Harrell’s C-index (0.553 to 0.576; p = 0.033) and NRI (22.3%; p < 0.001). In participants <65 years, supine hypertension showed the strongest association with AF, but no significant association was observed in older adults.
Conclusion
Supine hypertension is independently associated with increased AF risk, especially in younger adults. Combined seated and supine hypertension provides additive prognostic value for predicting AF. Incorporating supine BP may enhance AF risk stratification.