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Blood pressure status affects atrial fibrillation in diabetic end-stage renal disease

Kyung-Do Han1, YouMi Hwang2,3, Sang Hyun Park4

  • 1Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.

Plos One
|April 4, 2023
PubMed

Insights

Hypertension significantly increases atrial fibrillation (AF) risk in diabetic end-stage renal disease (ESRD) patients. Uncontrolled or new-onset hypertension, high diastolic blood pressure (≥100 mmHg), and high pulse pressure are key risk factors for AF in this population.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Atrial fibrillation (AF) prevalence is rising, particularly in aging populations.
  • Hypertension, diabetes, and chronic kidney disease are established AF risk factors.
  • The specific impact of hypertension on AF risk in diabetic end-stage renal disease (ESRD) remains unclear due to multimorbidity.

Purpose of the Study:

  • To investigate the effect of varying blood pressure control levels on AF prevalence within the diabetic ESRD population.
  • To clarify the independent contribution of hypertension to AF risk in patients with diabetic ESRD.

Main Methods:

  • Analysis of 13,859 diabetic ESRD patients from the Korean National Health Insurance Service database (2005-2019).
  • Patients were categorized into five groups based on blood pressure and hypertension medication history: normal, pre-hypertension, new onset hypertension, controlled hypertension, and uncontrolled hypertension.
  • Cox proportional-hazards models were used to estimate AF risk across different blood pressure groups.

Main Results:

  • New onset, controlled, and uncontrolled hypertension groups exhibited significantly higher AF risk compared to normotensive individuals.
  • In patients receiving antihypertensives, a diastolic blood pressure of ≥100 mmHg was strongly associated with increased AF risk.
  • Elevated pulse pressure was also identified as a significant risk factor for AF in patients on antihypertensive medication.

Conclusions:

  • Overt hypertension and a history of hypertension are significant predictors of AF in patients with diabetic ESRD.
  • Specific blood pressure thresholds, including diastolic blood pressure ≥100 mmHg and pulse pressure >60 mmHg, are associated with elevated AF risk in this vulnerable population.
Abstract

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