Among 8,807 hypertensive adults enrolled in the SPRINT trial, atrial fibrillation (AF) was independently associated with a dramatically elevated risk of injurious falls — a hazard ratio of 1.79 for baseline AF and 1.89 for time-updated AF (95% CI, 1.32–2.71). Crucially, neither standard nor intensive blood pressure lowering modified this association (interaction P=0.964), and findings held across sensitivity analyses including competing-risk and temporal-lag models.
This finding carries meaningful clinical weight. Clinicians managing hypertensive patients with AF routinely face a compound dilemma: anticoagulants reduce stroke risk but amplify bleeding consequences of falls, while aggressive BP control raises orthostatic hypotension concerns. This analysis — the largest to date specifically examining AF and injurious falls in a hypertensive cohort — offers partial reassurance that intensive BP targets do not worsen fall vulnerability beyond AF's independent contribution. That distinction matters practically: it suggests clinicians need not deprioritize intensive BP control out of fall-risk concern for AF patients.
Limitations are notable. SPRINT excluded diabetics and those with prior stroke, limiting generalizability. AF detection relied on ECGs and clinical events rather than continuous monitoring, likely undercounting paroxysmal AF. Falls were self-reported, introducing recall bias. The mechanism — whether AF drives falls via hemodynamic instability, medication burden, or fatigue — remains unexplored. As a preprint not yet peer-reviewed, these results require independent validation before informing clinical guidelines.
