Affiliation:
1. Division of Cardiology USC Keck School of Medicine Los Angeles California USA
2. Department of Biostatistics University of Alabama at Birmingham Birmingham Alabama USA
3. School of Public Health University of Alabama at Birmingham Birmingham Alabama USA
4. Department of Epidemiology University of Alabama at Birmingham Birmingham Alabama USA
5. Department of Medicine Epidemiological Cardiology Research Center (EPICARE), Section of Cardiovascular Medicine, Wake Forest School of Medicine Winston‐Salem North Carolina USA
Abstract
AbstractBackgroundThe association of hypertension (HTN) severity and control with the risk of incident atrial fibrillation (AF) is unclear.HypothesisIncreased HTN severity and poorer blood pressure control would be associated with an increased risk of incident AF.MethodsThis analysis included 9485 participants (mean age 63 ± 8 years; 56% women; 35% Black). Participants were stratified into six mutually exclusive groups at baseline—normotension (n = 1629), prehypertension (n = 704), controlled HTN (n = 2224), uncontrolled HTN (n = 4123), controlled apparent treatment‐resistant hypertension (aTRH) (n = 88), and uncontrolled aTRH (n = 717). Incident AF was ascertained at the follow‐up visit, defined by either electrocardiogram or self‐reported medical history of a physician diagnosis. Multivariable logistic regression analyses adjusted for demographic and clinical variables.ResultsOver an average of 9.3 years later, 868 incident AF cases were detected. Compared to those with normotension, incident AF risk was highest for those with aTRH (controlled aTRH: odds ratio (OR) 2.95; 95% confidence interval (CI) 1.60, 5.43, & uncontrolled aTRH: OR 2.47; 95% CI 1.76, 3.48). The increase in AF risk was smaller for those on no more than three antihypertensive agents regardless of their blood pressure control (controlled OR 1.72; 95% CI 1.30, 2.29 and uncontrolled OR 1.56; 95% CI 1.14, 2.13).ConclusionsThe risk of developing AF is increased in all individuals with HTN. Risk is highest in those aTRH regardless of blood pressure control. A more aggressive approach that focuses on lifestyle and pharmacologic measures to either prevent HTN or better control HTN during earlier stages may be particularly beneficial in reducing related AF risk.
Funder
National Institute of Neurological Disorders and Stroke
Subject
Cardiology and Cardiovascular Medicine,General Medicine