on behalf of the J-RHYTHM Registry Investigators* Background--To clarify the influence of hypertension and blood pressure (BP) control on thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J-RHYTHM Registry was performed.

Background Blood pressure (BP) variability has reportedly been a risk factor for various clinical events. To clarify the influence of BP visit‐to‐visit variability on adverse events in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J‐RHYTHM Registry was performed. Methods and Results Of 7406 outpatients with nonvalvular atrial fibrillation from 158 institutions, 7226 (age, 69.7±9.9 years; men, 70.7%), in whom BP was measured 4 times or more (14.6±5.0 times) during the 2‐year follow‐up period or until occurrence of an event, constituted the study group. SD and coefficient of variation of BP values were calculated as BP variability. Thromboembolism, major hemorrhage, and all‐cause death occurred in 110 (1.5%), 121 (1.7%), and 168 (2.3%) patients, respectively. When patients were divided into quartiles of systolic BP‐SD (<8.20, 8.20–10.49, 10.50–13.19, and ≥13.20 mm Hg), hazard ratios (HRs) for all adverse events were significantly high in the highest quartile compared with the lowest quartile (HR, 2.00, 95% CI, 1.15–3.49, P =0.015 for thromboembolism; HR, 2.60, 95% CI, 1.36–4.97, P =0.004 for major hemorrhage; and HR, 1.85, 95% CI, 1.11–3.07, P =0.018 for all‐cause death) after adjusting for components of the CHA 2 DS 2 ‐VASc score, warfarin and antiplatelet use, atrial fibrillation type, BP measurement times, and others. These findings were consistent when BP‐coefficient of variation was used instead of BP‐SD. Conclusions Systolic BP visit‐to‐visit variability was significantly associated with all adverse events in patients with nonvalvular atrial fibrillation. Further studies are needed to clarify the causality between BP variability and adverse outcomes in patients with nonvalvular atrial fibrillation. Registration URL: https://www.umin.ac.jp/ctr/ ; Unique Identifier: UMIN000001569.

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It is unclear whether tumour markers are generally increased in the serum and bronchoalveolar lavage fluid (BALF) of patients with pulmonary alveolar proteinosis (PAP). To clarify this point, levels of tumour markers were measured in the serum and BALF of patients with PAP. Squamous cell carcinoma (SCC) antigen, carcinoembryonic antigen (CEA), and carbohydrate antigens sialyl Lewis (CA 19-9) and sialyl SSEA-1 (SLX) were assayed with radioimmunoassay kits. Cytokeratin 19 fragments (CYFRA) were measured by enzyme-linked immunosorbent assay. Values for the tumour markers in serum, except for SCC, exceeded cut-off values in some PAP patients. Levels of the markers were higher in BALF compared with those in serum, and were significantly elevated in PAP patients compared with control subjects. There was a significant inverse correlation between CA19-9 level in BALF and arterial oxygen tension (PaO2) in PAP patients. A gradual elevation of CA19-9 and SLX was observed in a patient who showed a decrease in PaO2 level during the study period. In the light of these findings, it is possible that levels of tumour markers in BALF, especially levels of CA19-9 and SLX, may reflect the severity of the disease in PAP patients.

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