Atrial Fibrillation and Isolated Systolic Hypertension

Abstract

Abstract-We performed a post hoc analysis of the Systolic Hypertension in the Elderly Program database to assess the incidence of atrial fibrillation in the elderly hypertensive population, its influence on cardiovascular events, and whether antihypertensive treatment can prevent its onset. The Systolic Hypertension in the Elderly Program was a double-blind placebo-controlled trial in 4736 subjects with isolated systolic hypertension aged Ն60 years. Atrial fibrillation was an exclusion criterion from the trial. Participants were randomly assigned to stepped care treatment with chlorthalidone and atenolol (nϭ2365) or placebo (nϭ2371). The occurrence of atrial fibrillation and cardiovascular events over 4.7 years as well as the determination of cause of death at 4.7 and 14.3 years were followed. Ninety-eight subjects (2.06%) developed atrial fibrillation over 4.7 years mean follow-up, without significant difference between treated and placebo groups. Atrial fibrillation increased the risk for: total cardiovascular events (RR Key Words: hypertension Ⅲ elderly Ⅲ atrial fibrillation Ⅲ chlorthalidone Ⅲ atenolol Ⅲ incidence Ⅲ death A trial fibrillation (AF) represents a major health problem, affecting more than 2 million patients in the United States. 1 The prevalence of AF increases with age and it is estimated to be around 5% above age 70. 2 In the Framingham study the incidence of AF in the general population approximately doubled for every 10-year increment in age beyond 50 years (approximately 10% in persons who reach age 80 3,4 ), and it was reported as high as 19.2 per 1000 person-years among adults above age 65 in the Cardiovascular Health Study. 5 Arterial hypertension is an independent risk factor for developing AF 3 and for an increased risk of stroke in patients with AF. 6 However, no study addressed specifically the incidence of AF, the relationship of AF on cardiovascular events, and the effect of antihypertensive treatment versus placebo on the incidence of AF in a well-characterized hypertensive population. To answer these questions we performed a posthoc analysis of the Systolic Hypertension in the Elderly Program (SHEP) database. Methods Participants and Study DesignSHEP was a double-blind, randomized, placebo-controlled trial design to test whether long-term administration of antihypertensive treatment to older persons with isolated systolic hypertension (SBP Ͼ160 mm Hg and DBP Ͻ90 mm Hg) reduces the combined incidence of fatal and nonfatal stroke during a 5-year follow-up. A cohort of 4736 men and women aged Ն60 years with hypertension as defined was followed up for an average of 4.7 years. Patients were randomized in a double-blind manner to a once-daily dose of either active drug treatment or matching placebo. The objective of the stepped care treatment program was to use the minimal amount of medication to maintain SBP at or below the goal (decrease in baseline SBP of at least 20 mm Hg and a SBP of less than 160 mm Hg). The first treatment step was chlorthalidone 12.5 mg/d (or matching placebo), ...

Blood Pressure Variability and Risk of New-Onset Atrial Fibrillation

“…Two trials had 3 treatment arms, resulting in 13 comparisons between groups reporting both VR and OR for new-onset AF. [5][6][7][8][9][10][11][12][13] There was significant heterogeneity between trials in effects of treatment on VR (PϽ0.0001; Figure 1) and in effects on new-onset AF (Pϭ0.0017). However, lower VR was unrelated to new-onset AF either on meta-analysis (group with lower versus higher SD SBP: ORϭ1.02; 95% CI 0.90 to 1.15; 125 878 patients; 13 comparisons; Figure 1) or on metaregression (log OR versus log VR SBP r 2 ϭ0.109, Pϭ0.270; Figure 2).…”

“…New-onset AF was significantly reduced by randomization to an angiotensin receptor blocker in 2 trials (versus a ␤-blocker/calcium channel blocker) 6,7 with a trend in a pooled analysis of all angiotensin receptor blockers versus other drug comparisons (ORϭ0.85; 0.71 to 1.01; Pϭ0.067; 4 trials; 47 482 patients), but there were no parallel effects of angiotensin receptor blockers on VR SBP or diastolic BP. There were no other drug class effects in any individual trial or in pooled analyses.…”

Fibrin D-Dimer, Tissue-Type Plasminogen Activator, von Willebrand Factor, and Risk of Incident Stroke in Older Men

“…Because a high proportion of men had systolic blood pressure Ն140 mm Hg (63.6%) and the majority would be classified as having hypertension on the basis of systolic blood pressure Ն140 mm Hg, we used the higher threshold of systolic blood pressure of Ն160 mm Hg, as used in the Systolic Hypertension in the Elderly Program. 27 Hypertension in this older cohort was defined as systolic blood pressure Ն160 or diastolic blood pressure Ն90 or using antihypertensive treatment.…”

Hypertension and atrial fibrillation: epidemiology, pathophysiology and therapeutic implications

“…5 --7 On the other hand, hypertension is one of the important risk factors for the occurrence of AF, 8 and increased the risk of stroke and cardiovascular mortality in patients with AF. 9,10 Compare with other risk factors for AF, hypertension appears to be responsible for more AF than any other risk factor because of its high prevalence. However, the pathophysiological link between AF and hypertension remains unclear.…”