{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:48:02Z","timestamp":1791895682402,"version":"4.3.4"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Adelaide University","id":[{"id":"https:\/\/ror.org\/028g18b61","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Health and Medical Research Council of Australia","id":[{"id":"https:\/\/ror.org\/011kf5r70","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Hypertension carries the highest attributable risk for atrial fibrillation (AF) and strongly influences clinical outcomes such as stroke and death; however, the optimal blood pressure targets in individuals with AF remain poorly defined. We aimed to characterize the dose-response relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) and ischaemic stroke, all-cause mortality, and intracranial haemorrhage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We systematically searched MEDLINE, Embase, and Scopus for studies reporting outcomes in AF stratified by SBP and DBP. A two-stage dose-response meta-analysis used restricted cubic splines to model non-linearity, with within-study correlation handled by the Greenland\u2013Longnecker method. Twenty-three studies (17 cohorts; n = 476 750) were included. SBP demonstrated a U-shaped association with all-cause mortality, with the lowest risk at 134 mmHg (relative risks (RR) 0.92, 0.86\u20130.98 vs. 120 mmHg). DBP exhibited a J-shaped association, with the lowest risk at 83 mmHg (RR 0.99, 0.97\u20131.02). In contrast to mortality, the risks of ischaemic stroke, intracranial haemorrhage, and stroke or systemic embolism rose progressively with SBP, with a steepening gradient. At 140 vs. 120 mmHg, the RR was 1.51 for intracranial haemorrhage against 1.08 for ischaemic stroke, reaching 1.99 vs. 1.14 at 150 mmHg.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SBP exhibits a U-shaped relationship with all-cause mortality in patients with AF, balancing against a monotonic increase in ischaemic stroke and intracranial haemorrhage at higher pressures. A pragmatic target SBP of 120\u2013130 mmHg with DBP kept above \u223c75\u201380 mmHg, appears to optimize the balance between stroke prevention, bleeding risk, and survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag223","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:32:55Z","timestamp":1787923975000},"source":"Crossref","is-referenced-by-count":0,"title":["Non-linear associations between blood pressure and clinical outcomes in atrial fibrillation: a systematic review and dose-response meta-analysis"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1912-9923","authenticated-orcid":false,"given":"Elnaz","family":"Shahmohamadi","sequence":"first","affiliation":[{"name":"Centre for Heart Rhythm Disorders, Adelaide University and Royal Adelaide Hospital , 1 Port Road, Adelaide SA, Adelaide 5000 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Heart Rhythm Disorders, Adelaide University and Royal Adelaide Hospital , 1 Port Road, Adelaide SA, Adelaide 5000 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4106-9771","authenticated-orcid":false,"given":"Melissa E","family":"Middeldorp","sequence":"additional","affiliation":[{"name":"Centre for Heart Rhythm Disorders, Adelaide University and Royal Adelaide Hospital , 1 Port Road, Adelaide SA, Adelaide 5000 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3803-8429","authenticated-orcid":false,"given":"Prashanthan","family":"Sanders","sequence":"additional","affiliation":[{"name":"Centre for Heart Rhythm Disorders, Adelaide University and Royal Adelaide Hospital , 1 Port Road, Adelaide SA, Adelaide 5000 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