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Orthostatic hypotension and long-term incidence of atrial fibrillation: the Malmö Preventive Project

A Fedorowski1, B Hedblad, G Engström

  • 1Center for Emergency Medicine, Skåne University Hospital, Malmö, Sweden. artur.fedorowski@med.lu.se

Journal of Internal Medicine
|August 12, 2010
PubMed

Insights

Orthostatic hypotension (OH) predicts new cases of atrial fibrillation, particularly in hypertensive individuals. This finding highlights a potential link between autonomic dysfunction and heart rhythm disorders.

Area of Science:

  • Cardiology
  • Autonomic Neuroscience
  • Epidemiology

Background:

  • Orthostatic hypotension (OH) is a recognized risk factor for mortality and cardiovascular disease.
  • The association between OH and atrial fibrillation (AF) incidence remains understudied.
  • Autonomic dysfunction, characterized by OH, may influence cardiac electrophysiology.

Purpose of the Study:

  • To investigate the incidence of atrial fibrillation in relation to baseline orthostatic hypotension.
  • To determine if OH is an independent predictor of new-onset atrial fibrillation.
  • To examine this association within a large, population-based cohort.

Main Methods:

  • Prospective cohort study of 33,346 individuals from the Malmö Preventive Project.
  • Baseline assessment of orthostatic hypotension using international consensus criteria.
  • Kaplan-Meier and multivariable Cox proportional hazard models were used for analysis over ~24 years of follow-up.

Main Results:

  • 6.1% of participants had baseline OH.
  • New-onset atrial fibrillation occurred in 3.0 events/1000 person-years.
  • OH independently predicted atrial fibrillation incidence (HR: 1.30; P=0.016), especially in hypertensive individuals (HR: 1.44; P=0.008).

Conclusions:

  • Orthostatic hypotension is an independent predictor of atrial fibrillation incidence in middle-aged hypertensive individuals.
  • The findings suggest a significant role for autonomic dysfunction in AF development.
  • Further research is warranted to explore the link between autonomic dysfunction, OH, and AF.
Abstract

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