A PROSPECTIVE STUDY ON THE ASSOCIATION BETWEEN ATRIAL FIBRILLATION AND BLOOD PRESSURE IN AN ELDERLY CHINESE POPULATION

Abstract

Objective: In the present prospective study, we investigated the association between atrial fibrillation (AF) and blood pressure (BP) in an elderly Chinese population. Design and method: Elderly (aged 65 years and over) residents were recruited from 6 communities in Shanghai from 2006 to 2020. 9019 participants who did not have AF at baseline had at least one ECG recording during follow-up. BP status at baseline was defined according to the European hypertension guidelines as optimal, normal, or high-normal BP, and stage 1, 2 or 3 hypertension. Results: During a median of 3.5 years follow-up, the overall incidence rate of AF was 5.6 per 1000 person-years (n = 178, men vs. women: 7.0 vs. 4.5 per 1000 person-years, P = 0.008). The AF incidence increased with both higher systolic and diastolic BP. Statistical significance was achieved for age- and sex-adjusted hazard ratio (HR) relative to optimal BP in stage 2 or 3 systolic hypertension (1.78, 95% confidence interval [CI] 1.04–3.05, P = 0.03) and in stage 1 (1.67, 95% CI 1.01–2.77, P = 0.04) and stage 2 or 3 systolic and diastolic hypertension (1.93, 95% CI 1.11–3.33, P = 0.02) and for fully adjusted HR relative to optimal BP in stage 2 or 3 systolic and diastolic hypertension (1.76, 95% CI 1.00–3.08, P = 0.05). The association between AF incidence and BP status tended to be stronger in participants with no than those with a history of cardiovascular disease at baseline (P for interaction = 0.06). Indeed, in participants with no history of cardiovascular disease at baseline, multivariate-adjusted HRs of AF relative to their counterparts with optimal BP were statistically significant in stage 1 (1.76, 95% CI 1.00–3.11 P = 0.05) and stage 2 or 3 systolic hypertension (2.08, 95% CI 1.12–3.85, P = 0.02) and stage 1 (1.93, 95% CI 1.06–3.50, P = 0.03) and stage 2 or 3 systolic and diastolic hypertension (2.34, 95% CI 1.24–4.44, P = 0.01). Conclusions: In the Chinese people aged 65 years and over, AF incidence is higher with high BP, especially systolic hypertension and in the absence of cardiovascular disease.