Factors aggravating the course of atrial fibrillation in comorbid hypertension and type 2 diabetes mellitus

Abstract

Atrial fibrillation (AF) is quite a common problem, and its frequency increases with age. The course of this rhythm disturbance in comorbid conditions of hypertension and diabetes mellitus (DM) may depend on many pathophysiological factors. Therefore, the study on factors of AF development and aggravation in these comorbidities remains relevant. Aim. The work aimed at determining the factors of development and aggravation of AF in patients with hypertension and type 2 DM. Materials and methods. 214 patients with AF, hypertension and type 2 DM were examined. They were distributed into groups: 1) isolated AF – 7.5 %; 2) AF and hypertension – 51.9 %; 3) AF, hypertension and DM – 25.2 %; 4) isolated hypertension – 5.1 %; 5) hypertension and DM – 10.3 %. The paroxysmal form of AF was revealed in 34.3 %, persistent – in 46.4 % and constant – in 19.3 %. Results. It was revealed that persons with taller stature experienced arrhythmia symptoms more frequently (P = 0.01). Sex, Quetelet index, height, duration of hypertension, SBP, glucose, glycated Hb, urea, fibrinogen, triglycerides, interventricular septum and left ventricular posterior wall thickness, LV ejection fraction, concentric type of remodeling influenced the development of next AF episode in conditions of comorbid hypertension and DM. Quetelet index (P = 0.03), duration of AH (P = 0.03), and glycated Hb level (P = 0.002) were the most significant factors for frequent AF recurrences. A history of at least one AF episode increased the risk of developing a subsequent one by 5.56 times (Р = 0.01). An increase in LA was significantly influenced by AF. Hypertension also contributed to cardiac remodeling, namely, its hypertrophy, while the presence of DM only enhanced this effect. The increase in LА over 4.43 cm (P = 0.0001) and RV over 2.59 cm (P = 0.02) significantly increased the risk of АF conversion to the permanent form. Conclusions. A special attention should be paid to such parameters as Quetelet index, duration of AH, elevated BP, daily SBP variability, glycated Hb level and fasting glycemia, echocardiography indexes (EF, size of LA and RV) to prevent the occurrence of AF and its chronicity in patients with hypertension and DM.