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. (both PϽ0.001) 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 PϽ0.01) 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. Key Words: fibrillation Ⅲ hypertension, essential Ⅲ stroke Ⅲ hypertrophy Ⅲ echocardiography Ⅲ aging T he most important risk factors for atrial fibrillation (AF) are age, male gender, hypertension, thyrotoxicosis, smoking, diabetes, left ventricular (LV) hypertrophy, left atrial enlargement, valvular and coronary heart disease, congestive heart failure, and stroke. [1][2][3][4][5] In the Framingham Heart Study, hypertension and diabetes were the sole cardiovascular risk factors to be predictive of AF after controlling for age and other predisposing conditions. 5 The role of hypertension as risk factor for AF is established but still incompletely known. In the Manitoba Follow-up study, prevalence of hypertension was 53%, and the risk of AF was 1.42 times higher in hypertensive subjects as compared with normotensive subjects. 2 Because of its high prevalence in the population, hypertension independently accounts for more AF cases than any other risk factor. 5 However, despite its leading importance as a highly prevalent and modifiable risk factor, only a few data are available regarding predictors and outcome of AF in large populations of subjects with essential hypertension free of coexisting valvular or coronary heart disease, congestive heart failure, hyperthyroidism, or other predisposing conditions. In particular, the clinical value of LV mass as a potential independent predictor of AF in the specific setting of essential hypertension has never been examined in a large cohort of subjects. MethodsThe Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study started in 1986 as an observational registry of morbidity and mortality in initially untreated subjects with essential hypertension. Details on protocol have been pu...

Abstract-We investigated whether protection from coronary heart disease (CHD) and stroke conferred by angiotensinconverting enzyme inhibitors (ACEIs) and calcium channel blockers (CCBs) in hypertensive or high-risk patients may be explained by the specific drug regimen. We extracted summary statistics regarding CHD and stroke from 28 outcome trials that compared either ACEIs or CCBs with diuretics, ␤-blockers, or placebo for a total of 179 122 patients, 9509 incident cases of CHD, and 5971 cases of stroke. CHD included myocardial infarction and coronary death. In placebo-controlled trials, ACEIs decreased the risk of CHD (PϽ0.001), and CCBs reduced stroke incidence (PϽ0.001).There were no significant differences in CHD risk between regimens based on diuretics/␤-blockers and regimens based on ACEIs (Pϭ0.46) or CCBs (Pϭ0.52). The risk of stroke was reduced by CCBs (Pϭ0.041) but not by ACEIs (Pϭ0.15) compared with diuretics/␤-blockers. Because heterogeneity between trials was significant, we investigated potential sources of heterogeneity by metaregression. Examined covariates were the reduction in systolic blood pressure (BP), drug treatment (ACEIs versus CCBs), their interaction term, sex, age at randomization, year of publication, and duration of treatment. Prevention of CHD was explained by systolic BP reduction (PϽ0.001) and use of ACEIs (Pϭ0.028), whereas prevention of stroke was explained by systolic BP reduction (Pϭ0.001) and use of CCBs (Pϭ0.042). These findings confirm that BP lowering is fundamental for prevention of CHD and stroke. However, over and beyond BP reduction, ACEIs appear superior to CCBs for prevention of CHD, whereas CCBs appear superior to ACEIs for prevention of stroke.

Abstract-Chronic periodontitis has been associated with an increased risk for cardiovascular disease. Left ventricular mass is an established independent predictor of cardiovascular disease. In the present cross-sectional study, we tested the association between periodontitis and left ventricular mass in subjects with essential hypertension. One hundred four untreated subjects with essential hypertension underwent clinical examinations, including echocardiographic study, laboratory tests, and assessment of periodontal status according to the community periodontal index of treatment needs (CPITN eriodontium is a complex and highly specialized pressure-sensing system consisting of 4 tissues (cementum, periodontal ligament, alveolar bone, and junctional and sulcular epithelia) supporting the teeth. Of these structures, periodontal ligament is a dynamic tissue with a high rate of remodeling and turnover, which connects the teeth to the alveolar bone. 1 Prevalence of periodontal disease approaches 14% over a wide age span, including younger and elderly people. 1 Periodontitis begins with a loss of alveolar bone and subsequent formation of a pocked around the tooth, the final stage being tooth mobility and loss. 2 Periodontal pocket can be detected with a periodontal probe and estimated through measurement of distance from gingival margin to the base of the periodontal pocket. 3 In a healthy periodontium, there is no loss of epithelial attachment or pocket formation, and the gingival crevice is Ͻ2 mm deep. 3 Established risk factors for periodontal disease are dental plaque, calculus, age, genetics, smoking, and diabetes. 4 At least 9 cohort studies 5-13 examined the association between periodontal disease and coronary heart disease (CHD), with conflicting results. An overview of these studies 14 showed a 15% excess risk of CHD in association with periodontal disease, with 95% confidence intervals ranging from 8% to 122%. To define the underlying mechanisms of such association, several studies, reviewed in depth by Armitage, 15 examined the potential link between periodontal disease and cardiovascular risk factors, including diabetes, smoking, hyperlipidemia, and hypertension. Surprisingly, despite the high prevalence of hypertension in the general population and its leading prognostic importance, few data are available on the relation between elevated blood pressure (BP), hypertensive organ damage, and periodontal disease. Castelli et al 16 found a proliferation of the intima and elastic layers with lumen reduction of vessels feeding the periodontal membrane in hypertensive subjects. 16 In another study, tooth position and movements were affected by the force of BP transmitted through periodontal vessels. 17 Interestingly, periodontal pulsation reflected changes in pulse pressure rather than in mean BP. 17 Left ventricular (LV) mass is abnormally increased in about one third of people with hypertension, 18 and LV hypertrophy is associated with an excess risk of cardiovascular complications independently of BP and oth...

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