Wearable device for continuously blood pressure monitoring enable atrial fibrillation risk

BACKGROUND: The epidemiological data have linked atrial fibrillation (AF) risk with hypertension. The surging wearable devices allow noninvasive beat-by-beat blood pressure monitoring. OBJECTIVE: The present study aimed to investigate dynamic changes on blood pressure with wearable blood pressure monitors and its-related risk for AF occurrence. METHODS: In the mobile Atrial Fibrillation Application (mAFA II) programme, the subjects used the photoplethysmography (PPG)-based smart devices to detect the AF episodes. They simultaneously freely decided whether to take the wearables to monitor their blood pressure. RESULTS: There were 25388 subjects (mean age ± standard deviation, SD, 48±12 years old, 90.4% male) who received simultaneously blood pressure and cardiac rhythm monitoring with the wearables between Jan 1, 2022 and March 19, 2022. The monitored time (median, interquartile) were 6 (12–18) days and the number of measurements of blood pressure were 16 (3–56). The 8830 subjects (34.8%, 8830/25388) monitored with average 24-hour BP >130/80 mm Hg and 945 subjects (10%, 945/8830) with pulse differential over 60 mmHg. The extreme-dippers blood pressure and reverse-dippers blood pressure were in 8563 subjects (33.7%, 8563/25388) and 7018 subjects (27.6%, 7018/25388), respectively. There were 498 subjects (58±12 years, 89% male) who identified with AF. After adjusting age, gender, diabetes, obstructive sleep apnea, heart failure, coronary artery disease, and hyperthyroidism, the average 24-hour BP >130/80 mm Hg (Odd ratio, OR, 95% confidential interval, CI, 1.38, 1.12–1.69, p=0.002), the reverse-dippers blood pressure (OR, 95% CI, 1.29, 1.07–1.56, p=0.008) and pulse differential over 60 mmHg (OR, 95% CI, 1.76,1.17–2.64, p=0.006) independently predicted the risk of AF. CONCLUSION: Wearable devices with beat-by-beat monitoring demonstrated that not only high average 24-hour BP, but also reverse-dippers blood pressure and pulse differential over 60 mmHg increased AF susceptibility, which informing the clinical application of personalized “upstream risk control” of AF. FUNDING ACKNOWLEDGEMENT: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China