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Atrial fibrillation in hypertension: predictors and outcome
Paolo Verdecchia1, GianPaolo Reboldi, Roberto Gattobigio
1Dipartimento Malattie Cardiovascolari, Ospedale Silvestrini-Università di Perugia, Italy. verdec@tin.it
Insights
In hypertensive individuals, older age and increased left ventricular mass independently predict atrial fibrillation (AF). Larger left atrial size also predicts chronic AF, which is linked to higher stroke risk.
Area of Science:
- Cardiology
- Hypertension Research
- Electrophysiology
Background:
- Atrial fibrillation (AF) incidence and predictors in hypertensive patients are not fully understood.
- Essential hypertension is a common condition with potential cardiovascular complications.
Purpose of the Study:
- To investigate the incidence, determinants, and outcomes of atrial fibrillation in initially untreated hypertensive subjects.
- To identify independent predictors of new-onset and chronic atrial fibrillation.
Main Methods:
- Prospective follow-up of 2482 initially untreated hypertensive subjects in sinus rhythm for up to 16 years.
- Exclusion of subjects with pre-existing heart, thyroid, or lung conditions.
- Statistical analysis to identify predictors of atrial fibrillation and its chronicization.
Main Results:
- The incidence of new-onset atrial fibrillation was 0.46 per 100 person-years.
- Independent predictors for atrial fibrillation were age and left ventricular mass.
- Left atrial diameter predicted chronic atrial fibrillation, which carried a higher risk of ischemic stroke.
Conclusions:
- In hypertensive patients without other major conditions, age and left ventricular mass are key risk factors for atrial fibrillation.
- Left atrial enlargement contributes to the progression of atrial fibrillation to a chronic state.
- Managing hypertension and monitoring cardiac structure are crucial for preventing AF and its complications.
Abstract:
Incidence, determinants, and outcome of atrial fibrillation in hypertensive subjects are incompletely known. We followed for up to 16 years 2482 initially untreated subjects with essential hypertension. At entry, all subjects were in sinus rhythm. Subjects with valvular heart disease, coronary artery disease, preexcitation syndrome, thyroid disorders, or lung disease were excluded. During follow-up, a first episode of atrial fibrillation occurred in 61 subjects at a rate of 0.46 per 100 person-years. At entry, subjects with future atrial fibrillation differed (all P<0.05) from those without by age (59 versus 51 years), office, and 24-hour systolic blood pressure (165 and 144 versus 157 and 137 mm Hg, respectively), left ventricular mass (58 versus 49 g/height[m](2.7)), and left atrial diameter (3.89 versus 3.56 cm). Age and left ventricular mass (both P<0.001) were the sole independent predictors of atrial fibrillation. For every 1 standard deviation increase in left ventricular mass, the risk of atrial fibrillation was increased 1.20 times (95% CI, 1.07 to 1.34). Atrial fibrillation became chronic in 33% of subjects. Age, left ventricular mass, and left atrial diameter (all P<0.01) were independent predictors of chronic atrial fibrillation. Ischemic stroke occurred at a rate of 2.7% and 4.6% per year, respectively, among subjects with paroxysmal and chronic atrial fibrillation. These data indicate that in hypertensive subjects with sinus rhythm and no other major predisposing conditions, risk of atrial fibrillation increases with age and left ventricular mass. Increased left atrial size predisposes to chronicization of atrial fibrillation.