Is there an association between the prevalence of atrial fibrillation and severity and control of hypertension? The REasons for Geographic And Racial Differences in Stroke study

Bhatt, Hemal; Gamboa, Christopher; Safford, Monika M.; Soliman, Elsayed Z.; Glasser, Stephen P.

doi:10.1016/j.jash.2016.05.007

“…Results from 2014 healthy middle-aged men enrolled in the Norwegian study (19) and have been followed up for a median period of 35 years showed that men with baseline SBP ≥140 mmHg and for those with SBP at 128-138 mmHg had 1. (20). Besides, in line with our findings, a cross-sectional study (10) enrolled 6,966 elderly residents and suggested a negative relationship between SBP and prevalent AF (per 10 mmHg increase, OR=0.79, 95% CI: 0.71-0.88, P<0.0001).…”

Section: Discussionsupporting

confidence: 86%

Association of systolic blood pressure with atrial fibrillation among treated hypertensive patients

Chen¹,

Liu²,

Yu³

et al. 2020

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Background: Although many studies have suggested the association between elevated blood pressure and atrial fibrillation (AF), how the relationship between systolic blood pressure (SBP) and AF differ by antihypertensive treatment has been unclear. Therefore, this study aimed to explore the relationship between SBP and AF in hypertensive patients with or without antihypertensive treatment.Methods: This was a cross-sectional study that enrolled 7,808 hypertensive patients aged ≥18 years old in 2013 in Guangdong, China. AF was screened and diagnosed by rest 12-lead electrocardiogram (ECG) or by self-reported. Patients were categorized into 5 groups according to a 10 mmHg increment in SBP. We then performed logistic regression and restricted cubic spline regression to evaluate the relationship between SBP and AF.Results: Out of 7,808 participants (women 52.9%, mean age 62.3 years), 78 cases of AF were identified.Both univariate and multivariate logistic regression illustrated that SBP associated with a lower chance of AF in all participants when SBP was treated as a continuous variable (P<0.05) or as a categorical variable (P for trend <0.001). Similar trend was found in patients with antihypertensive therapy (P for trend <0.001) but not for those without antihypertensive medications.Conclusions: Our findings suggested that higher SBP is associated with lower likelihood of AF among all hypertensive patients and participants with antihypertensive treatment.

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“…The prevalence of atrial fibrillation in stroke patients in some studies was 4.3% [ 16 ]. Meanwhile, the other studies included in this study had the prevalence of atrial fibrillation in stroke patients by 8.6% [ 17 ]. Atrial fibrillation is one of the most common cardiac arrhythmias found to increase the risks of heart failure and stroke as well as to increase the mortality in cardiovascular diseases [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

The Modifiable Risk Factors of Uncontrolled Hypertension in Stroke: A Systematic Review and Meta-Analysis

Upoyo

¹

,

Setyopranoto

²

,

Pangastuti

³

2021

Stroke Research and Treatment

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Objective. This review aimed at figuring out the risk factors of uncontrolled hypertension in stroke. Method. This study systematically analyzed the hypertension risk factors available in the ProQuest, EBSCO, and PubMed databases published between 2010 and December 2019. The risk factors’ pooled odds ratio (POR) included in this research was calculated using both fixed and random-effect models. The meta-data analysis was processed using the Review Manager 5.3 (Rev Man 5.3). Result. Of 1868 articles, seven studies were included in this review searched using specific keywords. Based on the analysis results, there were 7 risk factors of uncontrolled hypertension in stroke: medication nonadherence ( POR = 2.23 [95% CI 1.71-2.89], p = 0.342 ; I 2 = 6.7 % ), use of antihypertensive drugs ( POR = 1.13 [95% CI 1.19-1.59, p = 0.001 ; I 2 = 90.9 % ), stage of hypertension ( POR = 1.14 [95% CI 1.02-1.27], p = < 0.001 ; I 2 = 97.1 % ), diabetes mellitus ( POR = 0.71 [95% CI 0.52-0.99], p = < 0.001 ; I 2 = 96.5 % ), atrial fibrillation ( POR = 1.74 [95% CI 1.48-2.04)], p = < 0.001 ; I 2 = 93.1 % ), triglycerides ( POR = 1.47 [95% CI 1.23-1.75], p = 0.879 ; I 2 = 0 % ), and age ( POR = 1.03 [95% CI 0.89-1.18], p = < 0.001 ; I 2 = 97.5 % ]. There were no bias publications among studies. Medication nonadherence and triglycerides had homogeneous variations, while the others had heterogeneous variations. Conclusion. Medication nonadherence, triglycerides, stage of hypertension, atrial fibrillation, and use of antihypertensive drugs significantly affect the uncontrolled hypertension in stroke.

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“…13,14 The inconsistent findings of anti-hypertensive therapy studies and observational studies has led some to question the strength of the direct relationship between blood pressure and AF or argue that it is driven by isolated subpopulations. [15][16][17][18] Preventative studies on a population scale are difficult to accomplish in a randomized and adequately powered fashion with sufficient duration. To overcome this limitation, this study employed a population genetics-based approach within a Mendelian randomization framework to better understand the causal role of blood pressure on risk of AF.…”

Section: Introductionmentioning

confidence: 99%

Blood Pressure and Risk of Atrial Fibrillation: A Mendelian Randomization Study

Hyman

¹

,

Levin

²

,

Walker

³

et al. 2020

Preprint

1

0

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Importance: Observational studies have shown an association between hypertension and atrial fibrillation (AF). Aggressive blood pressure management in patients with known AF reduces overall arrhythmia burden, but it remains unclear whether hypertension is causative for AF. Objective: The primary objective of this study was to investigate the relationship between blood pressure and risk of AF using genetic proxies for blood pressure within a Mendelian randomization (MR) framework. We secondarily explored the relationship between genetically proxied use of anti-hypertensive drugs and risk of AF. Design: Two-sample MR was performed using an inverse-variance weighted meta-analysis with weighted median MR and Egger intercept tests performed as sensitivity analyses. Genetic proxies for the anti-hypertensive drug classes were used to investigate the impact of these therapies on the risk of AF. Setting: International Consortium of Blood Pressure, UK Biobank and Atrial Fibrillation Genetics Consortium. Participants: Summary statistics for systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) were obtained from the International Consortium of Blood Pressure and the UK Biobank discovery analysis (>750,000 individuals of European ancestry). Summary statistics for AF were obtained from the 2018 Atrial Fibrillation Genetics Consortium multi-ethnic GWAS (>65,000 AF cases and >522,000 referents). Exposure: Genetically predicted SBP, DBP and PP as quantified by risk scores. Main Outcome: Odds ratio for AF per 10 mmHg increase in genetically proxied blood pressure. Results: Ten mmHg increases in genetically proxied SBP, DBP or PP were associated with increased odds of AF (SBP: OR 1.17, 95% CI 1.11-1.22, p=1x10-11; DBP: OR 1.25, 95% CI 1.16-1.35, p=3x10-8; PP: OR 1.1, 95% CI 1.0-1.2, p=0.05). Ten mmHg decreases in SBP estimated by genetic proxies of anti-hypertensive medications showed calcium channel blockers (OR 0.66, 95% CI 0.57-0.76, p=8x10-9) and beta-blockers (OR 0.61, 95% CI 0.46-0.81, p=6x10-4) decreased the risk of AF. Conclusions and Relevance: Blood pressure-increasing genetic variants were associated with increased risk of AF, consistent with a causal relationship between blood pressure and AF. These data support the concept that blood pressure reduction through pharmacologic intervention, and specifically calcium channel blockade or beta blockade could reduce the risk of AF.

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Is there an association between the prevalence of atrial fibrillation and severity and control of hypertension? The REasons for Geographic And Racial Differences in Stroke study

Cited by 14 publications

References 44 publications

Association of systolic blood pressure with atrial fibrillation among treated hypertensive patients

Association of systolic blood pressure with atrial fibrillation among treated hypertensive patients

The Modifiable Risk Factors of Uncontrolled Hypertension in Stroke: A Systematic Review and Meta-Analysis

Blood Pressure and Risk of Atrial Fibrillation: A Mendelian Randomization Study

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