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Zhang W, Chen Y, Hu LX, Xia JH, Ye XF, Cheng YB, Wang Y, Guo QH, Li Y, Lowres N, Freedman B, Wang JG. New-onset hypertension as a contributing factor to the incidence of atrial fibrillation in the elderly. Hypertens Res 2024; 47:1490-1499. [PMID: 38438728 DOI: 10.1038/s41440-024-01617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/20/2024] [Accepted: 01/27/2024] [Indexed: 03/06/2024]
Abstract
Hypertension and atrial fibrillation are closely related. However, hypertension is already prevalent in young adults, but atrial fibrillation usually occurs in the elderly. In the present analysis, we investigated incident atrial fibrillation in relation to new-onset hypertension in an elderly Chinese population. Our study participants were elderly (≥65 years) hypertensive residents, recruited from community health centers in the urban Shanghai (n = 4161). Previous and new-onset hypertension were defined as the use of antihypertensive medication or elevated systolic/diastolic blood pressure (≥140/90 mmHg), respectively, at entry and during follow-up on ≥ 2 consecutive clinic visits. Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG. During a median of 2.1 years follow-up, the incidence rate of atrial fibrillation was 7.60 per 1000 person-years in all study participants; it was significantly higher in patients with new-onset hypertension (n = 368) than those with previous hypertension (n = 3793, 15.76 vs. 6.77 per 1000 person-years, P = 0.02). After adjustment for confounding factors, the hazard ratio for the incidence of atrial fibrillation was 2.21 (95% confidence interval 1.15-4.23, P = 0.02) in patients with new-onset hypertension versus those with previous hypertension. The association was even stronger in those aged ≥ 75 years (hazard ratio 2.70, 95% confidence interval 1.11-6.56, P = 0.03). In patients with previous hypertension, curvilinear association (P for non-linear trend = 0.04) was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension. Our study showed a significant association between new-onset hypertension and the incidence of atrial fibrillation in elderly Chinese. In an elderly Chinese population with previous and new-onset hypertension, we found that the new-onset hypertension during follow-up, compared with previous hypertension, was associated with a significantly higher risk of incident atrial fibrillation. In patients with previous hypertension, curvilinear association was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension.
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Affiliation(s)
- Wei Zhang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei-Xiao Hu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia-Hui Xia
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Fei Ye
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nicole Lowres
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ben Freedman
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Wang C, Du Z, Ye N, Liu S, Geng D, Sun Y. Prevalence and prognosis of atrial fibrillation in a hypertensive population: A prospective cohort study. J Clin Hypertens (Greenwich) 2023; 25:335-342. [PMID: 36866435 PMCID: PMC10085811 DOI: 10.1111/jch.14643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 03/04/2023]
Abstract
Identifying risk factors for atrial fibrillation (AF) and evaluating their impact are essential to avoid the occurrence of adverse events. However, few studies to date have explored the prevalence, risk factors, and prognosis of AF in hypertensive patients. The objective of this study was to investigate the epidemiology of AF in a hypertensive population and determine the relationship between AF and all-cause mortality. At baseline, a total of 8541 Chinese patients with hypertension were enrolled from the Northeast Rural Cardiovascular Health Study. A logistic regression model was established to assess the relationship between blood pressure and AF, and Kaplan-Meier survival curve analysis and multivariate Cox regression were used to explore the relationship between AF and all-cause mortality. Meanwhile, subgroup analyses illustrated the robustness of results. This study found that the overall prevalence rate of AF was 1.4% in its Chinese hypertensive population. After adjusting for the confounding factors, every standard deviation increase in diastolic blood pressure (DBP) was associated with a 37% increase in the prevalence of AF (95% confidence interval: 1.152-1.627, p < .001). Compared to hypertensive patients without AF, those with AF had an increased risk of all-cause mortality (hazard ratio = 1.866, 95% confidence interval: 1.117-3.115, p = .017) in the adjusted model. The results show that the burden of AF is quite large in rural-dwelling Chinese hypertensive patients. Focusing on the control of DBP to prevent the occurrence of AF can be helpful. Meanwhile, AF increases risk of all-cause mortality in hypertensive patients. Our results indicated a huge burden of AF. Considering that most of the risk factors of AF were unmodifiable in hypertensive individuals and given their high risk of mortality, long-term interventions, including AF education, timely screening, and widespread use of anticoagulant drugs, should be emphasized in hypertensive populations.
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Affiliation(s)
- Chang Wang
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhi Du
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ning Ye
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Songyue Liu
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Danxi Geng
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yingxian Sun
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Coccina F, Pierdomenico AM, De Rosa M, Lorenzo B, Foglietta M, Petrilli I, Vitulli P, Pizzicannella J, Trubiani O, Cipollone F, Renda G, Pierdomenico SD. Risk of Atrial Fibrillation in Masked and White Coat Uncontrolled Hypertension. Am J Hypertens 2021; 34:504-510. [PMID: 33186441 DOI: 10.1093/ajh/hpaa185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/17/2020] [Accepted: 11/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Risk of atrial fibrillation (AF) in masked and white coat uncontrolled hypertension (MUCH and WUCH, respectively) has not yet been investigated. We assessed the risk of new-onset AF in MUCH and WUCH detected by ambulatory blood pressure (BP) monitoring. METHODS The occurrence of AF was evaluated in 2,135 treated hypertensive patients aged >40 years, with baseline sinus rhythm, by electrocardiogram. Controlled hypertension (CH) was defined as clinic BP <140/90 mm Hg and daytime BP, regardless of nighttime BP, <135/85 mm Hg, MUCH as clinic BP <140/90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg, WUCH as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP <135/85 mm Hg, and sustained uncontrolled hypertension (SUCH) as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg. RESULTS MUCH was identified in 203 patients (9.5% of all the population, 29% of those with normal clinic BP) and WUCH in 503 patients (23.5% of all the population, 35% of those with high clinic BP). During the follow-up (mean 9.7 years), 116 cases of AF occurred. After adjustment for covariates, patients with MUCH (hazard ratio 2.02, 95% confidence interval, 1.06-3.85) and SUCH (hazard ratio 1.83, 95% confidence interval, 1.04-3.21) had higher risk of new-onset AF than those with CH, whereas those with WUCH (hazard ratio 1.12, 95% confidence interval, 0.59-2.13) did not. CONCLUSIONS When compared with patients with CH, those with MUCH and SUCH are at higher risk (approximately doubled) of new-onset AF, whereas those with WUCH are not.
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Affiliation(s)
- Francesca Coccina
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Anna M Pierdomenico
- Department of Medicine and Aging Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Matteo De Rosa
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Belli Lorenzo
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Melissa Foglietta
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Ivan Petrilli
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Piergiusto Vitulli
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Jacopo Pizzicannella
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Oriana Trubiani
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Giulia Renda
- Department of Neurosciences, Imaging and Clinical Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Sante D Pierdomenico
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
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Coccina F, Pierdomenico AM, De Rosa M, Cuccurullo C, Pierdomenico SD. Association of clinic and ambulatory blood pressure with new-onset atrial fibrillation: A meta-analysis of observational studies. J Clin Hypertens (Greenwich) 2021; 23:1104-1111. [PMID: 33951286 PMCID: PMC8678663 DOI: 10.1111/jch.14256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to perform a meta‐analysis of studies evaluating the association of clinic and daytime, nighttime, and 24‐h blood pressure with the occurrence of new‐onset atrial fibrillation. We conducted a literature search through PubMed, Web of science, and Cochrane Library for articles evaluating the occurrence of new‐onset atrial fibrillation in relation to the above‐mentioned blood pressure parameters and reporting adjusted hazard ratio and 95% confidence interval. We identified five studies. The pooled population consisted of 7224 patients who experienced 444 cases of atrial fibrillation. The overall adjusted hazard ratio (95% confidence interval) was 1.05 (0.98‐1.13), 1.19 (1.11‐1.27), 1.18 (1.11‐1.26), and 1.23 (1.14‐1.32), per 10‐mmHg increment in clinic, daytime, nighttime, and 24‐h systolic blood pressure, respectively. The degree of heterogeneity of the hazard ratio estimates across the studies (Q and I‐squared statistics) were minimal. The results of this meta‐analysis strongly suggest that ambulatory systolic blood pressure prospectively predicts incident atrial fibrillation better than does clinic systolic blood pressure and that daytime, nighttime, and 24‐h systolic blood pressure are similarly associated with future atrial fibrillation.
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Affiliation(s)
- Francesca Coccina
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Anna M Pierdomenico
- Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Matteo De Rosa
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Chiara Cuccurullo
- Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Sante D Pierdomenico
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
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Upoyo AS, Setyopranoto I, Pangastuti HS. The Modifiable Risk Factors of Uncontrolled Hypertension in Stroke: A Systematic Review and Meta-Analysis. Stroke Res Treat 2021; 2021:6683256. [PMID: 33680423 PMCID: PMC7929677 DOI: 10.1155/2021/6683256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/16/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This review aimed at figuring out the risk factors of uncontrolled hypertension in stroke. METHOD This study systematically analyzed the hypertension risk factors available in the ProQuest, EBSCO, and PubMed databases published between 2010 and December 2019. The risk factors' pooled odds ratio (POR) included in this research was calculated using both fixed and random-effect models. The meta-data analysis was processed using the Review Manager 5.3 (Rev Man 5.3). RESULT Of 1868 articles, seven studies were included in this review searched using specific keywords. Based on the analysis results, there were 7 risk factors of uncontrolled hypertension in stroke: medication nonadherence (POR = 2.23 [95% CI 1.71-2.89], p = 0.342; I 2 = 6.7%), use of antihypertensive drugs (POR = 1.13 [95% CI 1.19-1.59, p = 0.001; I 2 = 90.9%), stage of hypertension (POR = 1.14 [95% CI 1.02-1.27], p = <0.001; I 2 = 97.1%), diabetes mellitus (POR = 0.71 [95% CI 0.52-0.99], p = <0.001; I 2 = 96.5%), atrial fibrillation (POR = 1.74 [95% CI 1.48-2.04)], p = <0.001; I 2 = 93.1%), triglycerides (POR = 1.47 [95% CI 1.23-1.75], p = 0.879; I 2 = 0%), and age (POR = 1.03 [95% CI 0.89-1.18], p = <0.001; I 2 = 97.5%]. There were no bias publications among studies. Medication nonadherence and triglycerides had homogeneous variations, while the others had heterogeneous variations. CONCLUSION Medication nonadherence, triglycerides, stage of hypertension, atrial fibrillation, and use of antihypertensive drugs significantly affect the uncontrolled hypertension in stroke.
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Affiliation(s)
- Arif Setyo Upoyo
- Faculty of Health Sciences, Jenderal Soedirman University, Indonesia
- Doctoral Program of Nursing, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Indonesia
| | - Ismail Setyopranoto
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Indonesia
| | - Heny Suseani Pangastuti
- Department of Medical and Surgical Nursing, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Indonesia
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Hyman MC, Levin MG, Gill D, Walker VM, Georgakis MK, Davies NM, Marchlinski FE, Damrauer SM. Genetically Predicted Blood Pressure and Risk of Atrial Fibrillation. Hypertension 2021; 77:376-382. [PMID: 33390040 PMCID: PMC7803440 DOI: 10.1161/hypertensionaha.120.16191] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/18/2020] [Indexed: 01/02/2023]
Abstract
Observational studies have shown an association between hypertension and atrial fibrillation (AF). Aggressive blood pressure management in patients with known AF reduces overall arrhythmia burden, but it remains unclear whether hypertension is causative for AF. To address this question, this study explored the relationship between genetic predictors of blood pressure and risk of AF. We secondarily explored the relationship between genetically proxied use of antihypertensive drugs and risk of AF. Two-sample Mendelian randomization was performed using an inverse-variance weighted meta-analysis with weighted median Mendelian randomization and Egger intercept tests performed as sensitivity analyses. Summary statistics for systolic blood pressure, diastolic blood pressure, and pulse pressure were obtained from the International Consortium of Blood Pressure and the UK Biobank discovery analysis and AF from the 2018 Atrial Fibrillation Genetics Consortium multiethnic genome-wide association studies. Increases in genetically proxied systolic blood pressure, diastolic blood pressure, or pulse pressure by 10 mm Hg were associated with increased odds of AF (systolic blood pressure: odds ratio [OR], 1.17 [95% CI, 1.11-1.22]; P=1×10-11; diastolic blood pressure: OR, 1.25 [95% CI, 1.16-1.35]; P=3×10-8; pulse pressure: OR, 1.1 [95% CI, 1.0-1.2]; P=0.05). Decreases in systolic blood pressure by 10 mm Hg estimated by genetic proxies of antihypertensive medications showed calcium channel blockers (OR, 0.66 [95% CI, 0.57-0.76]; P=8×10-9) and β-blockers (OR, 0.61 [95% CI, 0.46-0.81]; P=6×10-4) decreased the risk of AF. Blood pressure-increasing genetic variants were associated with increased risk of AF, consistent with a causal relationship between blood pressure and AF. These data support the concept that blood pressure reduction with calcium channel blockade or β-blockade could reduce the risk of AF.
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Affiliation(s)
- Matthew C. Hyman
- From the Division of Cardiovascular Medicine (M.C.H., M.G.L., F.E.M.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michael G. Levin
- From the Division of Cardiovascular Medicine (M.C.H., M.G.L., F.E.M.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (M.G.L., S.M.D.)
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health (D.G.), Imperial College London, United Kingdom
- Department of Medicine, Centre for Pharmacology and Therapeutics, Hammersmith Campus (D.G.), Imperial College London, United Kingdom
- Department of Genetics, Novo Nordisk Research Centre Oxford, Old Road Campus, United Kingdom (D.G.)
- Clinical Pharmacology and Therapeutics Section, Institute of Medical and Biomedical Education and Institute for Infection and Immunity, St George’s, University of London, United Kingdom (D.G.)
- Clinical Pharmacology Group, Pharmacy and Medicines Directorate, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom (D.G.)
| | - Venexia M. Walker
- Department of Surgery (V.M.W., S.M.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Medical Research Council Integrative Epidemiology Unit (V.M.W., N.D.), University of Bristol, United Kingdom
- Bristol Medical School: Population Health Sciences (V.M.W.), University of Bristol, United Kingdom
| | - Marios K. Georgakis
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany (M.K.G.)
| | - Neil M. Davies
- Medical Research Council Integrative Epidemiology Unit (V.M.W., N.D.), University of Bristol, United Kingdom
| | - Francis E. Marchlinski
- From the Division of Cardiovascular Medicine (M.C.H., M.G.L., F.E.M.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Scott M. Damrauer
- Department of Surgery (V.M.W., S.M.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (M.G.L., S.M.D.)
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Coccina F, Pierdomenico AM, Ianni U, De Rosa M, De Luca A, Pirro D, Pizzicannella J, Trubiani O, Cipollone F, Renda G, Pierdomenico SD. Ambulatory blood pressure and risk of new-onset atrial fibrillation in treated hypertensive patients. J Clin Hypertens (Greenwich) 2021; 23:147-152. [PMID: 33242233 PMCID: PMC8029687 DOI: 10.1111/jch.14112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the influence of clinic and ambulatory blood pressure (BP) on the occurrence of new-onset atrial fibrillation (AF) in treated hypertensive patients. We studied 2135 sequential treated hypertensive patients aged >40 years. During the follow-up (mean 9.7 years, range 0.4-20 years), 116 events (new-onset AF) occurred. In univariate analysis, clinic, daytime, nighttime, and 24-h systolic BP were all significantly associated with increased risk of new-onset AF, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.22 (1.11-1.35), 1.36 (1.21-1.53), 1.42 (1.29-1.57), and 1.42 (1.26-1.60), respectively. After adjustment for various covariates in multivariate analysis, clinic systolic BP was no longer associated with increased risk of new-onset AF, whereas daytime, nighttime, and 24-h systolic BP remained significantly associated with outcome, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.09 (0.97-1.23), 1.23 (1.10-1.39), 1.16 (1.03-1.31), and 1.22 (1.06-1.40), respectively. Daytime, nighttime, and 24-h systolic BP are superior to clinic systolic BP in predicting new-onset AF in treated hypertensive patients. Future studies are needed to evaluate whether a better control of ambulatory BP might be helpful in reducing the occurrence of new-onset AF.
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Affiliation(s)
- Francesca Coccina
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Anna M. Pierdomenico
- Department of Medicine and Aging SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Umberto Ianni
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Matteo De Rosa
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Andrea De Luca
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Davide Pirro
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Jacopo Pizzicannella
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Oriana Trubiani
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Francesco Cipollone
- Department of Medicine and Aging SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Giulia Renda
- Department of Neurosciences, Imaging and Clinical SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Sante D. Pierdomenico
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
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Chen Y, Huang QF, Sheng CS, Lei L, Xu SK, Zhang W, Shao S, Wang D, Cheng YB, Wang Y, Guo QH, Zhang DY, Li Y, Li Y, Freedman SB, Wang JG. Cross-sectional Association Between Blood Pressure Status and Atrial Fibrillation in an Elderly Chinese Population. Am J Hypertens 2019; 32:777-785. [PMID: 31004151 DOI: 10.1093/ajh/hpz060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) and hypertension are prevalent chronic disease conditions in the elderly population. In the present cross-sectional study, we investigated the association between blood pressure (BP) and AF in an elderly Chinese population. METHOD Our elderly (≥65 years) subjects were residents recruited from 6 communities in Shanghai from 2006 to 2017. Atrial fibrillation was systematically screened by rest 12-lead electrocardiogram (ECG) or by a handheld single-lead ECG. BP status was defined according to the European hypertension guidelines as optimal, normal, or high-normal BP, and stage 1, 2, or 3 hypertension. RESULT In the 6,966 participants (women 56.0%, mean age: 72.3 years), the prevalence of AF was 3.3%, and the prevalence of hypertension was 58.7% (83.7% treated). In all participants, the association with prevalent AF was negative for systolic BP (odds ratio [OR] per 10-mm Hg increase 0.79, 95% confidence interval [CI]: 0.71-0.88, P < 0.0001) but positive for diastolic BP (OR per 5-mm Hg increase 1.11, 95% CI: 1.02-1.22, P = 0.02). In untreated participants (n = 3,544), the association with prevalent AF was U-shaped for both systolic and diastolic BP, with the nadir at high-normal BP and a significantly higher risk of prevalent AF in optimal systolic BP (OR: 3.11, 95% CI: 1.65-5.85, P = 0.004) and stage 2 or 3 diastolic hypertension relative to the nadir (OR: 8.04, 95% CI: 2.28-28.3, P = 0.001). CONCLUSION In the elderly population, BP shows a complicated relationship with prevalent AF, with high-normal BP at the lowest risk and optimal systolic BP and stage 2 or 3 diastolic hypertension at increased risks.
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Affiliation(s)
- Yi Chen
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi-Fang Huang
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Sheng Sheng
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Lei
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shao-Kun Xu
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhang
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuai Shao
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dian Wang
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong-Yan Zhang
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Li
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - S Ben Freedman
- Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Cardiology, Concord Hospital and Anzac Research Institute, Concord, Australia
| | - Ji-Guang Wang
- Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Verdecchia P, Angeli F, Reboldi G. Hypertension and Atrial Fibrillation: Doubts and Certainties From Basic and Clinical Studies. Circ Res 2019; 122:352-368. [PMID: 29348255 DOI: 10.1161/circresaha.117.311402] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hypertension and atrial fibrillation (AF) are 2 important public health priorities. Their prevalence is increasing worldwide, and the 2 conditions often coexist in the same patient. Hypertension and AF are strikingly related to an excess risk of cardiovascular disease and death. Hypertension ultimately increases the risk of AF, and because of its high prevalence in the population, it accounts for more cases of AF than other risk factors. Among patients with established AF, hypertension is present in about 60% to 80% of individuals. Despite the well-known association between hypertension and AF, several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. From an epidemiological standpoint, it is unclear whether the increasing risk of AF with blood pressure (BP) is linear or threshold. It is uncertain whether an intensive control of BP or the use of specific antihypertensive drugs, such as those inhibiting the renin-angiotensin-aldosterone system, reduces the risk of subsequent AF in hypertensive patients in sinus rhythm. Finally, in spite of the observational evidence suggesting a progressive relation between BP levels and the risk of thromboembolism and bleeding in patients with hypertension and AF, the extent to which BP should be lowered in these patients, including those who undergo catheter ablation, remains uncertain. This article summarizes the main basic mechanisms through which hypertension is believed to promote AF. It also explores epidemiological data supporting an evolutionary pathway from hypertension to AF, including the emerging evidence favoring an intensive BP control or the use of drugs, which inhibit the renin-angiotensin-aldosterone system to reduce the risk of AF. Finally, it examines the impact of non-vitamin K antagonist oral anticoagulants compared with warfarin in relation to hypertension.
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Affiliation(s)
- Paolo Verdecchia
- From the Struttura Complessa di Medicina, Dipartimento di Medicina, Ospedale di Assisi, Italy (P.V.); and Struttura Complessa di Cardiologia e Fisiopatologia Cardiovascolare, Dipartimento di Cardiologia (F.A.) and Dipartimento di Medicina Interna (G.R.), Università di Perugia, Italy.
| | - Fabio Angeli
- From the Struttura Complessa di Medicina, Dipartimento di Medicina, Ospedale di Assisi, Italy (P.V.); and Struttura Complessa di Cardiologia e Fisiopatologia Cardiovascolare, Dipartimento di Cardiologia (F.A.) and Dipartimento di Medicina Interna (G.R.), Università di Perugia, Italy
| | - Gianpaolo Reboldi
- From the Struttura Complessa di Medicina, Dipartimento di Medicina, Ospedale di Assisi, Italy (P.V.); and Struttura Complessa di Cardiologia e Fisiopatologia Cardiovascolare, Dipartimento di Cardiologia (F.A.) and Dipartimento di Medicina Interna (G.R.), Università di Perugia, Italy
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11
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Mourtzinis G, Schiöler L, Kahan T, Bengtsson Boström K, Hjerpe P, Hasselström J, Manhem K. Antihypertensive control and new-onset atrial fibrillation: Results from the Swedish Primary Care Cardiovascular Database (SPCCD). Eur J Prev Cardiol 2017; 24:1206-1211. [DOI: 10.1177/2047487317708266] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Georgios Mourtzinis
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden
| | - Linus Schiöler
- Department of Public Health and Community Medicine, University of Gothenburg, Sweden
| | - Thomas Kahan
- Department of Clinical Sciences, Karolinska Institutet, Sweden
| | | | - Per Hjerpe
- Research and Development Centre, Skaraborg Primary Care, Sweden
| | - Jan Hasselström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden
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