Orthostatic Change in Blood Pressure and Incidence of Atrial Fibrillation: Results from a Bi-Ethnic Population Based Study

Sunil K Agarwal,Alvaro Alonso,Josef Coresh,Kathryn M Rose,Ross J Simpson,Elsayed Z Soliman,Gerardo Heiss,Alanna M Chamberlain,Seamus P Whelton,Rajesh Gopalrao Katare

doi:10.1371/journal.pone.0079030

Abstract

BackgroundAutonomic fluctuations are associated with the initiation and possibly maintenance of atrial fibrillation (AF). However, little is known about the relationship between orthostatic blood pressure change, a common manifestation of autonomic dysfunction, and incident AF.MethodsWe examined whether supine-to-standing changes in systolic blood pressure (SBP) are associated with incident AF in 12,071 African American and white men and women aged 45–64 years, enrolled in the Atherosclerosis Risks in Communities (ARIC) study. Orthostatic hypotension (OH) was defined as a supine-standing drop in SBP by ≥20 mmHg or diastolic blood pressure by ≥10 mmHg. AF cases were identified based on study scheduled 12-lead ECG, hospital discharge ICD codes, and death certificates through 2009.ResultsOH was seen in 603 (5%) at baseline. During an average follow-up of 18.1 years, 1438 (11.9%) study participants developed AF. Incident AF occurred more commonly among those with OH than those without, a rate of 9.3 vs. 6.3 per 1000 person years, (p<0.001). The age, gender, and race adjusted hazard ratio (95%CI) of AF among those with OH compared to those without was 1.62 (1.34, 2.14). This association was attenuated after adjustment for common AF risk factors to HR 1.40 (1.15, 1.71), a strength similar to that of diabetes or hypertension with AF in the same model. A non-linear relationship between orthostatic change in SBP and incident AF was present after multivariable adjustment.ConclusionsOH is associated with higher AF incidence. Whether interventions that decrease OH can reduce AF risk remains unknown.

Highlights

Atrial fibrillation (AF) affects approximately 3 million North Americans and the prevalence is projected to double by 2050. [1,2] atrial fibrillation (AF) shares common risk factors with other cardiovascular diseases (CVD) including age, obesity, hypertension, diabetes, cigarette smoking, and preexisting heart disease. [3,4] not all individuals who develop AF have CVD risk factors, and in younger individuals as many as 45% may not have underlying CVD. [5] both divisions branches of the autonomic nervous system (ANS) i.e., sympathetic and parasympathetic may be strong modulators of the AF substrate, leading to the initiation and/or maintenance of AF [6]
We examined its association with between orthostatic hypotension (OH) and AF stratified by several risk groups including race, gender, diabetes, hypertension, intake of medications that may predispose to OH, and history of CHD
There was no significant difference in the association of OH with AF risk between the other sub-groups including no differences between whites and blacks

Summary

Introduction

Atrial fibrillation (AF) affects approximately 3 million North Americans and the prevalence is projected to double by 2050. [1,2] AF shares common risk factors with other cardiovascular diseases (CVD) including age, obesity, hypertension, diabetes, cigarette smoking, and preexisting heart disease. [3,4] not all individuals who develop AF have CVD risk factors, and in younger individuals as many as 45% may not have underlying CVD. [5] both divisions branches of the autonomic nervous system (ANS) i.e., sympathetic and parasympathetic may be strong modulators of the AF substrate, leading to the initiation and/or maintenance of AF [6]. [5] both divisions branches of the autonomic nervous system (ANS) i.e., sympathetic and parasympathetic may be strong modulators of the AF substrate, leading to the initiation and/or maintenance of AF [6]. The measurement of orthostatic blood pressure change is an easy, inexpensive, and relatively quick procedure that can provide some information about an individual’s ANS dys-regulation [8]. Prospective studies report that those with a substantial drop in their blood pressure upon standing categorized as orthostatic hypotension (OH) have reportedly a two-fold higher stroke risk, [9] and a 50–100% increased mortality rate than those without OH. Autonomic fluctuations are associated with the initiation and possibly maintenance of atrial fibrillation (AF). Little is known about the relationship between orthostatic blood pressure change, a common manifestation of autonomic dysfunction, and incident AF

Methods

Results

Conclusion