Association of Pulse Pressure With New-Onset Atrial Fibrillation in Patients With Hypertension and Left Ventricular Hypertrophy

Larstorp, Anne Cecilie K.; Ariansen, Inger; Gjesdal, Knut; Olsen, Michael Hecht; Ibsen, Hans; Devereux, Richard B.; Okin, Peter M.; Dahlöf, Björn; Kjeldsen, Sverre E.; Wachtell, Kristian

doi:10.1161/hypertensionaha.112.195032

Cited by 60 publications

(36 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8,13,14 Although, some, [16][17][18] but not all, 13 studies suggest that reductions in BP are associated with a reduced risk of AF, several studies have found that the increased risk of developing AF persists even into the upper normal range of BP, 17,19 raising the attractive hypothesis that more aggressive BP control in hypertensive patients could further reduce AF risk compared with standard BP control.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Lower On-Treatment Systolic Blood Pressure on the Risk of Atrial Fibrillation in Hypertensive Patients

et al. 2015

Self Cite

View full text Add to dashboard Cite

A trial fibrillation (AF) is a common arrhythmia 1,2 that is increasing in prevalence. 2 The incidence of AF increases with age 1 and is increased in patients with heart failure, left ventricular hypertrophy (LVH), coronary heart disease, and hypertension. [3][4][5][6][7][8][9][10][11][12][13][14] The higher risk of death, [3][4][5] sudden cardiac death, 6 heart failure, 5 and stroke 3,7,8 in patients with AF and the substantial risks associated with antithrombotic therapies aimed at decreasing the risk of embolic sequelae 15 make prevention of the development of new AF a major clinical and epidemiological goal.Hypertension is the most important risk factor for new AF, estimated to account for between 14% and 22% of the population-attributable risk 9,11 ; AF risk is also related to the severity of hypertension. 8,13,14 Some, [16][17][18] but not all, studies 13 suggest that reductions in blood pressure (BP) can reduce the risk of developing new AF. Recent work found that even upper normal levels of systolic BP (SBP) were associated with an increased long-term risk of AF,19 suggesting that more aggressive BP control may further decrease AF risk. More intensive antihypertensive treatment aimed at greater reduction of BP or a lower achieved pressure to further reduce cardiovascular risk has produced mixed outcomes 16,[20][21][22][23][24] and remains controversial. 25,26 However, there are only limited data on whether achievement of a lower SBP during treatment of hypertension is associated with a decreased risk of AF. 14,16 Therefore, the purpose of this study was to examine whether lower achieved SBP (≤130 mm Hg) is associated with a lower incidence of AF compared with typical SBP control (131-141 mm Hg) and less-adequate control (SBP ≥142 mm Hg) in hypertensive patients with ECG LVH, independent of treatment modality, baseline risk factors, in-treatment diastolic BP, and the previously demonstrated predictive value of in-treatment heart rate and regression of ECG LVH by Cornell product criteria for new AF in this population. 27,28Abstract-There is a well-established association between hypertension and atrial fibrillation (AF); indeed, even upper normal systolic blood pressures (SBP) are long-term predictors of incident AF. These findings suggest that more aggressive BP control may reduce the risk of new AF. However, whether lower achieved SBP is associated with a lower incidence of AF remains unclear. The risk of new-onset AF was examined in relation to last in-treatment SBP before AF diagnosis or last in-study measurement in the absence of new AF in 8831 hypertensive patients with ECG left ventricular hypertrophy with no history of AF, in sinus rhythm on their baseline ECG, randomly assigned to losartan-or atenololbased treatment. Patients with in-treatment SBP ≤130 mm Hg (lowest quintile at last measurement) and SBP between 131 and 141 mm Hg were compared with patients with in-treatment SBP ≥142 mm Hg (median SBP at last measurement). During follow-up of 4.6±1.1 years, new-onset AF was diagnosed in 701 patie...

show abstract

Section: Discussionmentioning

confidence: 99%

“…8,13,14 Some, [16][17][18] but not all, studies 13 suggest that reductions in blood pressure (BP) can reduce the risk of developing new AF. Recent work found that even upper normal levels of systolic BP (SBP) were associated with an increased long-term risk of AF, 19 suggesting that more aggressive BP control may further decrease AF risk.…”

mentioning

confidence: 99%

Effect of Lower On-Treatment Systolic Blood Pressure on the Risk of Atrial Fibrillation in Hypertensive Patients

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study, pulse pressure was the strongest BP variable predicting future atrial fibrillation. 25 Visit-to-visit BP was very high in patients on hemodialysis in a reanalysis of the Fosinopril in Dialysis (FOSIDIAL) study and was a strong predictor of cardiovascular events. 26 Day-to-day variability of home BP measurements was reduced significantly by a combination of angiotensin II receptor blocker and calcium channel blocker, and by more than an angiotensin II receptor blocker/diuretic combination in a Japanese study, perhaps because of effects on arterial stiffness.…”

Section: Old Ground New Findingsmentioning

confidence: 99%

Recent Clinical Trials of Hypertension Management

Jennings

2013

Hypertension

View full text Add to dashboard Cite

“…However, it should be pointed out that increments in the variables of arterial stiffness and function that were examined are typical for people with high blood pressure or history of hypertension and that the authors did not specifically address whether the association of these measures of arterial stiffness, pulsatile hemodynamics, and endothelial dysfunction with new AF were independent of the previously demonstrated predictive value of brachial blood pressure measurements in this population. In the Framingham Heart Study, 10 like in other studies, 8 peripheral pulse pressure was the dominating blood pressure component for predicting incident AF.…”

Section: Hypertensionmentioning

confidence: 67%

“…In addition, data from the same study suggested that reducing left atrial size during antihypertensive therapy translates into reduced risk of new-onset AF. 7 A recent and detailed analysis 8 shows that, in patients with left ventricular hypertrophy, pulse pressure was equivalent to systolic and diastolic blood pressures combined in predicting new-onset AF, but when forced into the same statistical model, the pulse pressure was by far the strongest predictor of new-onset AF among the various blood pressure components. This strong association with pulse pressure suggests that in advanced hypertensive disease, the stiff arteries with high hemodynamically increased afterload and stretch of atrial walls with atrial chamber dilation and pressure up into the pulmonary veins may be a key mechanism for promoting unstable electric properties that lead to AF.…”

Section: See Related Article Pp 590-596mentioning

confidence: 99%

Arterial Stiffness Predicts Incident Atrial Fibrillation in the Framingham Heart Study

et al. 2016

Self Cite

View full text Add to dashboard Cite

H ypertension is, due to the high prevalence in the general population, by far the most important risk factor for the development of atrial fibrillation (AF). A recent study confirmed that blood pressures even in the upper normal or prehypertensive range are associated with an increased risk of AF. 1 Independently, in people with high cardiovascular risk, 2 left ventricular hypertrophy, serum creatinine, history of hypertension, and history of cerebrovascular disease were highly significant predictors, as were body mass index and history of coronary heart disease. This analysis 2 of populations participating in 2 large outcome trials of similar design (n=30 424) documented the connection between hypertension, or its end-organ damage as well as risk factors, and the risk of incident AF. The relationship between the history of hypertension and risk of AF persists, despite confounding by the extensive vascular disease or complicated diabetes mellitus that the participants had, 2 or maybe these diseases even escalated the relationship.The dominating role of high blood pressure in the pathogenesis, pathophysiology, prediction, diagnosis, and treatment of AF has been extensively reviewed by a working group of the European Society of Hypertension.3 Perhaps the most remarkable finding was that up to ≈90% of patients with AF who participated in some of the recent large randomized clinical outcome trials of new anticoagulant or antiarrhythmic medications in people with AF had a history of hypertension 3 even without baseline workup using ambulatory 24-hour blood pressure measurements to detect people with masked hypertension. This suggests that AF is in most cases a typical complication of hypertension, and even more so than stroke or heart failure.It is not entirely surprising but confirmatory in a slightly different type of population that left ventricular hypertrophy is a strong predictor of AF. In a large study of patients with left ventricular hypertrophy (n=9193), blood pressures, Cornell voltage-duration product left ventricular hypertrophy on ECG, heart rate, age, and male sex were the predictors. 4 In this study, there was less incident AF with regression of left ventricular hypertrophy during antihypertensive treatment.5 Because a difference in stroke drove the difference in the primary end point in favor of angiotensin receptor blocker over β-blocker, 4,5 it is not particularly surprising that less new-onset AF during treatment with angiotensin receptor blocker compared with β-blocker contributed to fewer incident strokes and the difference in the primary composite end point. Furthermore, hypertension is a strong factor in not only remodeling left ventricular structure but also strongly related to left atrial size. 6 Increased left atrial size then implies stretching of the atrial myocardial fibers, which again leads to less cross-talk between atrial myocardial cells provoking AF. In addition, data from the same study suggested that reducing left atrial size during antihypertensive therapy translates into reduc...

show abstract

Association of Pulse Pressure With New-Onset Atrial Fibrillation in Patients With Hypertension and Left Ventricular Hypertrophy

Cited by 60 publications

References 59 publications

Effect of Lower On-Treatment Systolic Blood Pressure on the Risk of Atrial Fibrillation in Hypertensive Patients

Effect of Lower On-Treatment Systolic Blood Pressure on the Risk of Atrial Fibrillation in Hypertensive Patients

Recent Clinical Trials of Hypertension Management

Arterial Stiffness Predicts Incident Atrial Fibrillation in the Framingham Heart Study

Contact Info

Product

Resources

About