Blood Pressure (BP) in Atrial Fibrillation (AF)

1. Whether the (so called) modest elevation in BP, which increases the risk for incident AF, and subsequently, concomitant hypertension and AF accounting for a multiplied cardiovascular risk enhancement – remain to vary (significantly) – depending on individual’s metabolism?

2. What exactly we mean by “optimal BP” (corresponding to an individual), which requires lowering BP for mitigating risk for cardiovascular morbidity and mortality; and for those individuals, with the coupled effect of AF & hypertension?

Feasible to deduce the optimal BP for an individual from home BP & 24 h ambulatory BP monitoring?

Do we always have a positive correlation between ‘left ventricular hypertrophy’ and ‘left atrial size’ with ‘ambulatory BP monitoring’?

3. Do we have a control over hemodynamic changes associated with AF, that in turn, causing variations in BP? Or Could we track the reasons for ‘changes in BP’ in the absence of considering hemodynamic changes?

4.  If the accuracy of automated BP measurements in AF patients in an out-of-hospital setting remain to be suspicious, then, the development of AF detection algorithms implemented in an automated BP devices would successfully serve the intended purpose? How about false positives?

5. In the absence of details on a recorded sleeping hours of a concerned patient, what exactly we mean by daytime and night-time measurements of systolic & diastolic BP, Mean Arterial Pressure & Pulse Rate?

Whether, Pulse Pressure in such cases, would remain to be the simple difference between systolic BP & diastolic BP (irrespective of the HR being lesser or greater than 90 bpm)?

In the context of BP measurements, whether HR would remain to be critical at all, if it is less than 120 bpm?

Suresh Kumar Govindarajan Professor (HAG) IIT Madras