Risk of the highest quartile (Q4) of systolic blood pressure (BP)-standard deviation (SD) on adverse events compared with the lowest quartile (Q1) in patients with atrial fibrillation (AF). A, Thromboembolism; B, Major bleeding; C, All-cause death; D, Composite events. AFFIRM Study [8]: Systolic BP-SD quartiles are Q1, <10.09; Q2, 10.09–13.85; Q3, 13.86–17.33; and Q4, ≥17.34 mmHg. Thromboembolism includes stroke while composite events include stroke, major bleeding, or cardiovascular death. Hazard ratios were adjusted for congestive heart failure, hypertension, age, diabetes mellitus, stroke/transient ischemic attack (TIA), myocardial infarction, peripheral arterial disease, sex, warfarin use, time in therapeutic range, hepatic/renal disease, pulmonary disease, and randomized treatment. J-RHYTHM Registry [9]: The systolic BP-SD quartiles are Q1, <8.20; Q2, 8.20–10.49; Q3, 10.50–13.19; and Q4, ≥13.20 mmHg. Thromboembolism includes ischemic stroke, TIA, or systemic embolism (SE), and composite events include ischemic stroke, TIA, or SE, major bleeding, or all-cause death. Hazard ratios were adjusted for congestive heart failure, hypertension, age, diabetes mellitus, stroke/TIA, coronary artery disease, sex, warfarin and antiplatelet use, AF type, BP measurement times, creatinine clearance, body mass index, and hemoglobin levels. COOL-AF Registry [14]: The systolic BP-SD quartiles are Q1, 0.58–9.09; Q2, 9.11–12.15; Q3, 12.17–16.21; and Q4, 12.17–16.21 mmHg. Thromboembolism includes ischemic stroke or SE, and composite events include ischemic stroke, SE, or all-cause death. Hazard ratios were adjusted for age, sex, AF type, symptomatic AF, baseline systolic BP, history of heart failure, coronary artery disease, cardiac implantable electronic device, history of stroke/TIA, hypertension, diabetes, smoking, dyslipidemia, renal replacement therapy, dementia, chronic kidney disease, history of bleeding, antiplatelet use, anticoagulant type and CHA2DS2-VASc score. For the analysis of major bleeding, the HAS-BLED score was included. Generated from [8, 9], and [14]