Atrial Fibrillation In Hypertensive Patients Research Articles

Effects of ACEI/ARB or CCB use on atrial fibrillation in hypertensive patients following permanent pacemaker implantation.

Permanent pacemaker implantation (PPI) combined with hypertension leads to a higher risk of new-onset atrial fibrillation (NOAF) for patients. Hence, it is essential to study how to reduce this risk. Currently, the effects of the two common anti-hypertensive drugs, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and calcium channel blockers (CCB), on the risk of NOAF for such patients remain unknown. This study aimed to investigate this association. This single-center retrospective study included hypertensive patients with PPI and without prior history of AF/atrial flutter, heart valve disease, hyperthyroidism, etc. Patients were classified into ACEI/ARB group and CCB group based on their exposure drug information. The primary outcome was NOAF events that occurred within 12 months after PPI. The secondary efficacy assessments were the changes from baseline to follow-up in blood pressure and transthoracic echocardiography (TTE) parameters. A multivariate logistic regression model was used to verify our aim. A total of 69 patients were finally included (51 on ACEI/ARB and 18 on CCB). Both univariate analysis [odds ratio (OR) 0.241, 95% confidence interval (CI) 0.078-0.745] and multivariate analysis (OR: 0.246, 95% CI: 0.077-0.792) demonstrated that ACEI/ARB were associated with a lower risk of NOAF compared to CCB. The mean reduction in left atrial diameter (LAD) from baseline was greater in ACEI/ARB group than in CCB group (P = 0.034). There was no statistical difference between groups in blood pressure and other TTE parameters after treatment. For patients with PPI combined with hypertension, ACEI/ARB may be superior to CCB in selecting anti-hypertensive drugs, as ACEI/ARB further reduces the risk of NOAF. One reason for this may be that ACEI/ARB improves left atrial remodelling such as LAD better.

GLUCOSE METABOLISM AND ATRIAL FIBRILLATION IN HYPERTENSIVE PATIENTS

Objective: We evaluated the association of abnormal glucose metabolism with risk of atrial fibrillation in hypertensive patients. Design and method: The study comprised 34.280 consecutive patients (51,87% males, mean age 58 years) with uncomplicated essential hypertension. The diagnosis of hypertension was based upon repeated office blood pressure measurements, 24 hours ambulatory blood pressure monitoring, clinical and laboratory evaluation. Patients were divided into four metabolic groups: normal glucose (NG), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM2). Then subdivided into three subgroups: sinus (SR), paroxysmal (PAF) and sustained (SAF) atrial fibrillation. Average glucose (eAG), hemoglobin A1c (HbA1c), insulin, homeostatic model assessment for insulin resistance (HOMA-IR) and the variation of them in relation to rhythm were assessed in each subgroup, corrected for confounders. Results: Among the patients (45,3%) with NG there was significant difference of all glucose metabolic parameters in correlation to three rhythms (glucose p = 0,004, eAG, HbA1c, insulin, HOMA-IR, p<0,001). These indices were higher, in SAF and in PAF compared to the SR subgroup (glucose p = 0,011, the rest indices p<0,001). In group IFG (20,3%), comparison of three rhythm indicated significant difference of glucose indices (glucose, eAG p<0,05, HbA1c, insulin, p<0,001) and they were increased in PAF in contrast to SR patients (p<0,05). Additionally, the insulin and the HbA1c were higher in SAF comparison the SR patients, (p<0,05). The eAG was comparably higher in SAF versus the PAF group, (p<0,05). In group IGT (17,3%), the patients had difference in levels of indices depending the rhythm (eAG, HbA1c, insulin, HOMA-IR p<0,05). Particularly the patients with SAF had higher levels of insulin and HOMA-IR than those who had SR (p<0,05). In group T2DM (16,9%), there was significant difference in glucose parameters dependent the rhythm (glucose p = 0,031, insulin p = 0,002, eAG, HOMA-IR, HbA1c p<0,001). The subgroup PAF showed higher values in eAG, HbA1c, HOMA-IR, (p<0,05) and the subgroup SAF in glucose, insulin, eAG, HOMA-IR (p<0,05), HbA1c (p<0,001) in compare to SR subgroup, respectively. Conclusions: Prediabetes and diabetes increase the risk of atrial fibrillation in hypertensive patients in a level response way.

POSSIBLE PREDICTORS CONTRIBUTING TO AF OCCURRENCE IN HYPERTENSIVE PATIENTS

Objective: Arterial hypertension (AH) and atrial fibrillation (AF) are two important public health problems. Their prevalence is increasing worldwide, and often coexist in the same patient. AH and AF are strikingly related to an excess risk of cardiovascular disease and death. AH ultimately increases the risk of AF and several factors underlying the higher risk of AF in hypertensive patients are still incompletely known. AH is one of the main reasons for the remodeling process in these patients and makes a significant contribution to the development of structural changes. The aim of this study is to identify possible predictors of paroxysmal/persistent AF occurrence and progression in hypertensive patients Design and method: In this study where enrolled 219 hypertensive patients with non-valvular paroxysmal/persistent AF (mean age 63.6 ±7.4) who were hospitalized at Research Institute of Cardiology between 2016 and 2018 year. As a control group 94 hypertensive patients without AF were also examined. After the enrollment the echocardiography examination and 24-hour ambulatory Holter monitoring ECG were registered in each patient. We measured plasma indexes of inflammation (hsCRP, IL-6) and fibrosis marker TGF-beta1. The database consisting of 19 indicators that characterize the clinical, hemodynamic and structural-functional state of the heart, as well as markers of inflammation and fibrosis was created. All data were analyzed by SPSS 13 and EXCEL - 2013 programs using logistic analysis by odds ratio (OR). Results: The obtained results showed that in hypertensive patients with paroxysmal /persistent AF, OR of more episodes of hypertensive crises, deterioration of electrical remodeling and LV diastolic function, as well as a significant increase in the levels of concentrations of inflammatory and fibrosis markers in comported with hypertensive patients without AF were detected (tabl.1). Conclusions: The multifactorial analysis revealed significant impact of left atrial and ventricular dysfunction, inflammation and fibrosis as well as hypertensive crises on the possible risk of AF occurrence and progression in hypertensive patients

Baseline pr internal prolongation and elevated diastolic blood pressure are predictors of new-onset atrial fibrillation in hypertensive patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction One of the most significant risk factors for atrial fibrillation is hypertension (HTN) (AF). Although the PR interval is a factor in the Framingham risk score for AF, it has been linked to an elevated risk of incident AF. However, there is a lack of consistency in the findings identifying PR prolongation as a risk factor for AF. Purpose In a large cohort of HTN patients, we seek to assess the predictive value of the PR interval for the emergence of AF. Methods The average follow-up time for consecutive individuals with essential hypertension and no known AF at baseline was 5.3 years. Each patient underwent a 12-lead ECG, an echocardiogram examination, and a 24-hour Holter rhythm monitoring in the event of arrhythmia complaints. These tests were done at baseline and once a year. The European Society of Cardiology/European Society of Hypertension guidelines for HTN therapy were followed during the follow-up period, including routine clinical and paraclinical assessments and drug administration. The baseline ECG was used to determine the PR interval and P wave length. Results We included 1807 hypertensives (mean age 57±11 years; 49% men) with office systolic/diastolic blood pressure of 144±17/89±11 mmHg. A total of 65 occurrences of new-onset AF (3%) were reported during the follow-up period. P wave duration and PR internal time were longer at baseline in patients with new-onset AF (n=67) compared to those without AF (n=1740) (P wave, 115 vs 110 ms) (PR interval, 174 vs 157 ms). A multivariate Cox regression analysis showed that baseline P wave duration had no significant prognostic value for the occurrence of new-onset AF, but baseline PR internal was substantially linked with the development of AF (HR = 1.01, 95% CI = 1.01-1.02; p = 0.01). A greater incidence of AF was linked to baseline elevated diastolic blood pressure (HR 1.05, 95% 1.003-1.091; p=0.037). Conclusions Baseline PR internal and elevated diastolic blood pressure were significant predictors of new-onset AF in hypertensive patients. PR prolongation may be a marker for cardiovascular degenerative aging caused by vascular inflammation and myocardial fibrosis.

Prevalence and prognosis of atrial fibrillation in a hypertensive population: A prospective cohort study.

Identifying risk factors for atrial fibrillation (AF) and evaluating their impact are essential to avoid the occurrence of adverse events. However, few studies to date have explored the prevalence, risk factors, and prognosis of AF in hypertensive patients. The objective of this study was to investigate the epidemiology of AF in a hypertensive population and determine the relationship between AF and all-cause mortality. At baseline, a total of 8541 Chinese patients with hypertension were enrolled from the Northeast Rural Cardiovascular Health Study. A logistic regression model was established to assess the relationship between blood pressure and AF, and Kaplan-Meier survival curve analysis and multivariate Cox regression were used to explore the relationship between AF and all-cause mortality. Meanwhile, subgroup analyses illustrated the robustness of results. This study found that the overall prevalence rate of AF was 1.4% in its Chinese hypertensive population. After adjusting for the confounding factors, every standard deviation increase in diastolic blood pressure (DBP) was associated with a 37% increase in the prevalence of AF (95% confidence interval: 1.152-1.627, p<.001). Compared to hypertensive patients without AF, those with AF had an increased risk of all-cause mortality (hazard ratio=1.866, 95% confidence interval: 1.117-3.115, p=.017) in the adjusted model. The results show that the burden of AF is quite large in rural-dwelling Chinese hypertensive patients. Focusing on the control of DBP to prevent the occurrence of AF can be helpful. Meanwhile, AF increases risk of all-cause mortality in hypertensive patients. Our results indicated a huge burden of AF. Considering that most of the risk factors of AF were unmodifiable in hypertensive individuals and given their high risk of mortality, long-term interventions, including AF education, timely screening, and widespread use of anticoagulant drugs, should be emphasized in hypertensive populations.

Role of P Wave Duration and Tissue Doppler Imaging as Predictive Indicators for Paroxysmal Atrial Fibrillation in Hypertensive Patients

Background: Atrial fibrillation (AF) is the most prevalent chronic arrhythmia in the heart. AF accounts for one-third of rhythm disorder hospitalizations. AF increases profoundly the risk of stroke, heart failure, and death. This study used P-wave and transthoracic echocardiography with tissue Doppler imaging (TDI) to determine paroxysmal AF predictors in hypertensive individuals.&#x0D; Methods: This case control study was performed on 100 hypertensive adult patients. They were classified into two equal group: Group I included hypertensive patients diagnosed to have paroxysmal AF. Group II (control group) included hypertensive patients with normal sinus rhythm. All subjects were subjected to electrocardiographic and conventional and tissue Doppler Imaging measurements.&#x0D; Results: Pmax had significantly increased in PAF patients compared to sinus rhythm patients. PAL, PAR, PAI, LR, LI and IR had significantly increased in PAF patients compared to sinus rhythm patients. In Multivariate logistic regression analysis, Pmax, PAL, PAI, PAR, LR, LI and IR were found to be independent predictors for PAF. Therefore, Pmax, PAL PAI, PAR, LR, LI and IR were found to be significant predictors for PAF. Best cut-off values for Pmax, PAL, PAI, PAR, LR, LI and IR were: (118, 81, 61, 49.9, 34, 20 and 16 ms) with sensitivity (76, 96, 96, 88, 82, 86 and 77.5 ), specificity (84, 100, 98, 92, 78, 82 and 76) and the AUC of (0.850, 0.979, 0.987, 0.961, 0.836, 0.891 and 0.798) respectively.&#x0D; Conclusions: Electrocardiographic P-wave analysis and echocardiographic TDI may identify hypertension patients at risk for paroxysmal AF, since the combination of Pmax and TDI may help in predicting the development of AF in hypertensive individuals.

PS-C02-8: ROLE OF STATIN THERAPY IN HYPERTENSION, PLEIOTROPIC EFFECT IN REDUCING NEW-ONSET AF AND ISCHEMIC STROKE

Introduction: Hypertension is considered the most important risk factor for stroke in the general population, is the most common comorbidity in patients with atrial fibrillation (AF), and is prevalent in approximately 80 to 90% of subjects with AF enrolled in recent clinical trials. Statin drugs have potent anti inflammatory and antioxidant effects that have the potential to prevent AF. Patients who had ischemic stroke complications due to episodes of AF are usually asymptomatic, thus primary prevention of AF in hypertensive patients is very important. Objectives: To determine the effectiveness of statin in reducing the incidence of new onset AF and ischemic stroke complications in hypertensive patients. Methods: We included 180 subjects in this retrospective cohort study using medical records at Sanglah General Hospital from 2018 to 2020. Subjects were divided into hypertensive subjects who were treated with a statin and hypertensive subjects who were not given statins, and we tracked the incidence of new onset AF. Pearson chi square test was used to determine the association of baseline characteristics, comorbidities, and medications, including statin, on the outcome of new onset AF, ischemic stroke, and side effects of statin. The progression of new onset AF between groups was also compared with the Kaplan Meier curve. Results: Our subjects who used statin were 39.4%, the mean age for all was 51.51+12.31 with 28,3% new onset AF, 7,2% ischemic stroke, and 2.2% all cause death. Statin in hypertensive patients significantly reduced the incidence of new onset AF (PR 0.174; 95%CI 0.079–0.38; P &lt; 0.001) with a longer AF free period (19.16 + 2.57 vs 13.68 + 0.67 months; 95%CI 5.01–5.84; P = 0.014) and ischemic stroke free period (23.72 + 0.71 vs 16.57 + 1.06 month; 95%CI 5.01–5.84; P = 0.003), without any significant relationship with the adverse effect of statin. The incidence of AF was significantly high in hypertensive subjects with comorbid heart failure (HF) however, the AF free period remains longer if hypertensive patients with HF are given statin (19.16 + 2.57 vs 13.68 + 0.67 month; 95%CI 5.01–5.84; P = 0.014). Conclusion: Statin administration has the potential to be an effective treatment for primary prevention of the incidence of new onset AF and ischemic stroke in hypertensive patients without significant side effects.

Amlodipine can increase atrial fibrillation in hypertensive patients

The aim of this study is to determine the increased prevalence of Atrial Fibrillation (AF) in hypertensive patients who use Amlodipine (a Dihydropyridine Calcium Channel Blocker), as compared to hypertensive patients who do not use Amlodipine. The study carried out in Alkarama Teaching Hospital, Wasit Province, Iraq, during the period from April 2010 to February 2014. One hundred eighty eight adult hypertensive patients with AF were included, 109 males with mean age 52 ± 3.4 SD and 79 females with mean age 49 ± 4.1 SD. Subdivided in two groups: group A (include 118 patients using Amlodipine) and group B (include 70 patients do not use Amlodipine). The study showed an increase in the prevalence of (AF), more in those patients using Amlodipine than those who do not use Amlodipine regardless of gender. But there increase in AF in older age and those using higher doses for longer period.

Abstract 12983: Diagnostic Performance of an Automated Blood Pressure Monitor With an Irregular Heartbeat Algorithm Designed to Detect Atrial Fibrillation

Introduction: Patients with atrial fibrillation (AF) are constantly exposed to the risk of developing stroke, and early detection to initiate appropriate treatment for AF is important to prolong their healthy life. In previous reports, automated blood pressure (BP) monitors manufactured by A&amp;D Co., Ltd. was equipped with an irregular heartbeat (IHB) algorithm specifically designed to detect AF, suggesting its usefulness for AF monitoring in hypertensive patients with a high prevalence of AF. Purpose: The aim of this study was to evaluate the diagnostic performance for AF of the A&amp;D BP monitor UM-212 with an IHB algorithm in a clinical setting. Methods: A total of 242 consecutive patients was enrolled (mean age: 67.5 years, 62.3% male). BP measurements were performed three times per one patient using UM-212 and the presence or absence of IHB detection was recorded for each measurement. The definition of IHB algorithm designed to detect AF is as follows: the number of pulse waves varying more than 15% from the mean of the pulse peak interval is greater than 20% of the total pulse wave count. A 3ch real-time ECG was recorded during all BP measurements. The interpretation by automated ECG analysis software manufactured by Fukuda Denshi Co., Ltd. and the final ECG diagnosis by two cardiologists were performed separately. Results: Of the 242 patients, 31 had AF and 66 had non-AF arrhythmia. On a per-measurement basis (726 total), IHB detection had 98.9% of sensitivity and 90.7% of specificity for diagnosing AF. Under the same condition, ECG analysis software had 90.3% of sensitivity and 96.5% of specificity for diagnosing AF. On a per-patient basis, IHB detection in all three BP measurements had 96.8% of sensitivity and 95.7% of specificity for diagnosing AF. Under the same condition, ECG analysis software had 80.6% of sensitivity and 99.1% of specificity for diagnosing AF. Conclusions: The IHB algorithm designed to detect AF built into A&amp;D BP monitors showed high sensitivity and high specificity for diagnosing AF in a clinical setting, especially its sensitivity tended to exceed that of automated ECG analysis software. Utilizing the IHB algorithm during routine BP measurements is expected to monitor AF in hypertensive patients and contribute to their health management.

PR interval as arisk factor for atrial fibrillation in patients with arterial hypertension

Abstract Introduction Hypertension (HTN) is one of the most important risk factors associated with atrial fibrillation (AF). Prolongation of the PR interval has been associated with an increased risk of incident AF, while PR interval is a component of the Framingham risk score for AF. However, the results regarding PR prolongation as a risk factor for AF are inconsistent. Purpose We aim to evaluate the predictive role of the PR interval for AF development in a large cohort of HTN patients. Methods Consecutive patients with essential hypertension without known AF at baseline were followed up for a mean period of 5.3±3.3 years. A 12-lead ECG and an echocardiography study were performed on each patient at baseline and annually, and 24h Holter rhythm monitoring was used in the event of arrhythmia symptoms. Routine clinical and paraclinical examinations as well as medications were implemented during the follow-up period according to the European Society of Cardiology/ European Society of Hypertension guidelines for HTN management. The PR interval and P wave duration were obtained from the baseline ECG. Results We included 1807 hypertensives (mean age 57±11 years; 49% males) with office systolic blood pressure (SBP)/ diastolic blood pressure (DBP) 144±17/89±11mmHg. During the follow-up period, 65 cases (3%) of new-onset AF were recorded. Patients with new-onset AF (n=67) compared to those without AF (n=1740) had greater baseline P wave duration (115 vs 110 ms) and PR internal (174 vs 157 ms). Multivariable Cox regression analysis showed that higher baseline PR internal is significantly associated with the development of AF (HR 1.01, 95% CI 1.01–1.02; p=0.01), while there was no significant predictive value for baseline P wave duration on the incidence of new-onset AF. Baseline increased DBP was associated with a higher incidence of AF (HR 1.05, 95% 1.003–1.091; p=0.037). Conclusions Baseline PR internal is a significant predictor of new-onset AF in hypertensive patients. The PR prolongation could be considered as a marker for cardiovascular degenerative aging caused by vascular inflammation and myocardial fibrosis. Funding Acknowledgement Type of funding sources: None.

Associated factors and effects of comorbid atrial fibrillation in hypertensive patients due to primary aldosteronism.

The incidence of atrial fibrillation (AF) and risk of cardiovascular events are reportedly higher in patients with primary aldosteronism (PA) than essential hypertension. However, associated factors of comorbid AF and cardiovascular events in PA patients after PA treatment remain unclear. This nationwide registration study included PA patients ≥20 years old. Incident cardiovascular events were observed with a mean follow-up of approximately 3 years. A total of 3654 patients with PA were included at the time of analysis. Prevalence of AF was 2.4%. PA patients with AF were older, more frequently male and had longer duration of hypertension than those without AF. No significant difference in basal plasma and adrenal venous aldosterone concentration, renin activity, potassium concentration, confirmatory tests of PA, laterality or surgery rate were seen between groups. Logistic regression analysis showed age, male sex, cardiothoracic ratio, past history of coronary artery disease and heart failure were independent factors associated with AF. PA patients with AF showed a higher frequency of cardiovascular events than those without AF (P < 0.001). Multivariate Cox analyses demonstrated AF in addition to older age, duration of hypertension, body mass index and chronic kidney disease as independent prognostic factors for cardiovascular events after PA treatment. Incidence of cardiovascular events were significantly lower in PA patients with AF than AF patients from the Fushimi registry during follow-up after adjusting age, sex and systolic blood pressure. Early diagnosis of PA may prevent AF and other cardiovascular events in PA patients by shortening the duration of hypertension and appropriate PA treatment.

Study of serum uric acid and atrial fibrillation in hypertensive patients

Background: The aim is to study the correlation of serum uric acid and atrial fibrillation in hypertensive individuals and the effect of duration of hypertension on atrial fibrillation &amp; serum uric acid (SUA). Materials and Methods: Patients (age between 35-65years) were selected from outpatient OPD &amp; IPD. A control group of 100 non hypertensive individuals and another group of 100 hypertensive patients were enrolled. Serum uric acid, Echocardiography: A Trans Thoracic Echocardiography (TTE) measurement of Left atrium diameter (LVST), interventricular septal thickness (LVPWT), posterior wall thickness, left ventricular end diastolic diameter (LV) and LV ejection fraction (LVEF) was recorded. Results: Hyperuricemia incidence in controls was 11% and hyperuricemia incidence in cases was 65 %. The incidence of hyperuricemia in cases with phase 1 of hypertension was 6.27±1.22 mg/dl and those with phase 2 of hypertension was 7.59±1mg/dl which was significant. Atrial fibrillation incidence was 4% in the hypertensive patients and the atrial fibrillation incidence in normotensive patients was 1%. Conclusion: Hypertension duration had a significant effect on the SUA levels and revealed that there was noteworthy increase in the SUA level in individuals with atrial fibrillation than those without atrial fibrillation.

TIME-VARYING SERUM URIC ACID PREDICTS NEW-ONSET ATRIAL FIBRILLATION IN TREATED HYPERTENSIVE PATIENTS

Objective: The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study was the first clinical outcome trial to suggest that lowering of serum uric acid by a uricosuric drug such as losartan has a beneficial effect on cardiovascular outcome independently of changes in renal function or blood pressure. LIFE also showed less new-onset atrial fibrillation in hypertensive patients receiving losartan vs. atenolol based treatment. Because losartan reduces serum uric acid levels, we investigated relations of serum uric acid with new-onset atrial fibrillation in the study. Design and method: Hypertensive patients with electrocardiographic left ventricular hypertrophy and no prior atrial fibrillation (n = 8243) were treated for 5.0 ± 0.4 years with losartan or atenolol based therapy. Associations of serum uric acid with new-onset atrial fibrillation documented by Minnesota coding were assessed by Cox models using serum uric acid and systolic blood pressure as time-varying covariates to take into account changes of serum uric acid related to losartan or diuretic treatment, changes in renal function, and aging. Results: Time-varying serum uric acid was associated with new atrial fibrillation defined by Minnesota code (HR = 1.19 per 16.8 umol/L [1 mg/dL] [95% CIs, 1.12–1.26], P &lt; 0.0001), independent of losartan treatment (HR = 0.75 [95% CIs, 0.61–0.93], P = 0.007), older age (HR = 1.95 per 7.0 years [95% CIs, 1.73–2.20], P &lt; 0.0001), male sex (HR = 1.46 [95% CIs, 1.09–1.94], P = 0.010) and higher Cornell voltage duration product (HR = 1.10 per 1023 msec x mm [95% CIs, 1.01–1.21], P = 0.034). Similar results were obtained in Cox models with serum uric acid levels partitioned according to baseline quartiles and in which atrial fibrillation was defined by physician reports or by both Minnesota coding and physician reports. Conclusions: Thus, we found a strong relationship between time-varying serum uric acid levels during antihypertensive treatment and new-onset atrial fibrillation in elderly patients with left ventricular hypertrophy. Our data suggest that in-treatment serum uric acid is a strong predictor for new onset atrial fibrillation in hypertensive patients, independent of effects of antihypertensive treatment, age, sex, and electrocardiographic left ventricular hypertrophy. Further research is needed to clarify how serum uric acid may provoke atrial fibrillation.

ROLE OF SERUM URIC ACID LEVELS AND CRP IN THE EXISTENCE OF ATRIAL FIBRILLATION IN HYPERTENSIVE PATIENTS

Objective: The inflammatory effect of the serum uric acid and C-reactive protein (CRP) is evident, as well as the role and significance, of inflammation in the presence of atrial fibrillation. The aim of this study was to investigate a possible association between the serum uric acid levels with the existence of atrial fibrillation in hypertensive patients and the possible role of CRP in this status. Design and method: We studied 1196 hypertensive patients (45,1% female), treated or newly diagnosed untreated, of mean age: 63,1 ± 13,3 years, without any known cardiovascular disease and with mean office systolic/diastolic arterial blood pressure (S/DBPo): 142,1 ± 19.3/86.5 ± 12,6 mmHg, mean office heart rate (HRo): 73,7 ± 10,7 bpm, average body mass index (BMI): 28.5 ± 5,8 kg/m2and average waist circumference (WC) 96.1 ± 12.9 cm The levels of serum uric acid (SUA), C-reactive protein (CRP), urea, creatinine,were recorded. eGFR was calculated according Cockcroft-Gault Equation and the atrial fibrillation (AF) status was recorded. The study population was separated in two groups, according the existence or not of any evidence for AF Group A: with PAF or PEAF Group B: without AF By using the ANOVA statistic method we registered the SUA and CRP values in both groups. Using Pearson correlation method we correlated SUA with CRP serum levels. Results: Table 1: Differences of serum uric acid and CRP levels between group A and group B Table 2: Correlation between serum uric acid levels with C-reactive protein levels SUA: serum uric acid CRP: C-reactive protein Conclusions: In hypertensive patients treated or not, the presence of PAF or PEAF was associated with significantly higher serum uric acid levels and CRP levels, while a significant positive correlation exists between SUA and CRP levels in this population. possibly indicating their importance in the inflammatory status of hypertensive patients with atrial fibrillation.

PR INTERVAL DURATION AS A RISK FACTOR FOR NEW-ONSET ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Hypertension (HTN) is one of the most important risk factors associated with atrial fibrillation (AF). Prolongation of the PR interval has been associated with an increased risk of incident AF, while PR interval is a component of the Framingham risk score for AF. However, the results regarding PR prolongation as a risk factor for AF are inconsistent. We aim to evaluate the predictive role of the PR interval for AF development in a large cohort of HTN patients. Design and method: Consecutive patients with essential hypertension without known AF at baseline were followed up for a mean period of 5.3 ± 3.3 years. A 12-lead ECG and an echocardiography study were performed on each patient at baseline and annually, and 24 h Holter rhythm monitoring was used in the event of arrhythmia symptoms. Routine clinical and paraclinical examinations as well as medications were implemented during the follow-up period according to the European Society of Cardiology/ European Society of Hypertension guidelines for HTN management. The PR interval and P wave duration were obtained from the baseline ECG. Results: We included 1807 hypertensives (mean age 57 ± 11 years; 49% males) with office systolic blood pressure (SBP)/ diastolic blood pressure (DBP) 144 ± 17/89 ± 11mmHg. During the follow-up period, 65 cases (3%) of new-onset AF were recorded. Patients with new-onset AF (n = 67) compared to those without AF (n = 1740) had greater baseline P wave duration (115 vs 110 ms) and PR internal (174 vs 157 ms). Multivariable Cox regression analysis showed that higher baseline PR internal is significantly associated with the development of AF (HR 1.01, 95% CI 1.01–1.02; p = 0.01), while there was no significant predictive value for baseline P wave duration on the incidence of new-onset AF. Baseline increased DBP was associated with a higher incidence of AF (HR 1.05, 95% 1.003–1.091; p = 0.037). Conclusions: Baseline PR internal is a significant predictor of new-onset AF in hypertensive patients. The PR prolongation could be considered as a marker for cardiovascular degenerative aging caused by vascular inflammation and myocardial fibrosis.

Opportunistic screening for atrial fibrillation in hypertensive patients using a mobile application (prospective study of 160 cases)

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia,affecting between 1-4% of the general population and responsible for 10-20% of strokes. New technologies are now available for screening for AF,but their implementation in real clinical settings has not yet been fully investigated. Purpose -evaluate the electrocardiogram recordings on smartphones intended for screening for AF using the KardiaMobile device, with a dedicated mobile application. - Highlight the prevalence of AF in a moroccan hypertensive population -Evaluate the effectiveness of computerized screening for AF in therapeutic management Methods Prospective screening for AF in patients aged 55 or over,known to be hypertensive for at least 5 years, was performed at the cardiology consultation services between June 2019-July 2020.A single lead ECG was acquired by placing the fingers of each hand on the electrodesThe diagnosis of the Kardia app was assessed by the consultation cardiologist,and a baseline ECG was performed for each suspected arrhythmia.CHA2DS2-VASc score was collected from each patient. Results A total of 160 ECGs were performed.The diagnosis of the Kardia app was provided in 93% of cases.A heart rhythm described as normal was detected in 120 consultants,AFwas suspected in 8.1% of the patients described by the device as ‘possible AF’,and confirmed by a baseline ECG in 7.5% of the patients screened. Anti-coagulation was started in 6.2% of patients. Conclusion Mobile Device for screening for atrial fibrillation in a population at risk is a promising, inexpensive tool with significant prognostic benefit for the prevention of cardiovascular complications The Kardia app is able to quickly filter and detect atial fibrillation with high sensitivity and specificity.

Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive Patients.

Because of demographic aging, the prevalence of arterial hypertension (HTN) and cardiac arrhythmias, namely atrial fibrillation (AF), is progressively increasing. Not only are these clinical entities strongly connected, but, acting with a synergistic effect, their association may cause a worse clinical outcome in patients already at risk of ischemic and/or haemorrhagic stroke and, consequently, disability and death. Despite the well-known association between HTN and AF, several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. Although several trials reported the overall clinical benefit of renin–angiotensin–aldosterone inhibitors in reducing incident AF in HTN, the role of this class of drugs is greatly reduced when AF diagnosis is already established, thus hinting at the urgent need for primary prevention measures to reduce AF occurrence in these patients. Through a thorough review of the available literature in the field, we investigated the basic mechanisms through which HTN is believed to promote AF, summarising the evidence supporting a pathophysiology-driven approach to prevent this arrhythmia in hypertensive patients, including those suffering from primary aldosteronism, a non-negligible and under-recognised cause of secondary HTN. Finally, in the hazy scenario of AF screening in hypertensive patients, we reviewed which patients should be screened, by which modality, and who should be offered oral anticoagulation for stroke prevention.

Time-varying serum uric acid predicts new-onset atrial fibrillation in treated hypertensive patients. The LIFE Study

Aim: The Losartan Intervention For Endpoint reduction in hypertension (LIFE) Study showed less new-onset atrial fibrillation (AF) in hypertensive patients receiving losartan- vs. atenolol-based treatment. Because losartan reduces serum uric acid (SUA) levels, the aim of the present study was to investigate relations of SUA with new-onset AF in the study. Methods: Hypertensive patients with electrocardiographic (ECG) left ventricular hypertrophy (LVH) and no prior AF (n = 8,243) were treated for 5.0 ± 0.4 years with losartan- or atenolol-based therapy. Associations of SUA with new-onset AF documented by Minnesota coding were assessed by Cox models using SUA and systolic blood pressure as time-varying covariates to take into account changes of SUA related to losartan or diuretic treatment, changes in renal function, and aging. Results: Time-varying SUA was associated with new AF defined by Minnesota code [hazard ratio (HR) = 1.19 per 16.8 μmol/L (1 mg/dL), (95% confidence intervals (CIs), 1.12–1.26), P &lt; 0.0001], independent of losartan treatment [HR = 0.75 (95% CIs, 0.61–0.93), P = 0.007], older age [HR = 1.95 per 7.0 years (95% CIs, 1.73–2.20), P &lt; 0.0001], male sex [HR = 1.46 (95% CIs, 1.09–1.94), P = 0.010] and higher Cornell voltage-duration product [HR = 1.10 per 1,023 ms·mm (95% CIs, 1.01–1.21), P = 0.034]. Similar results were obtained in Cox models with SUA levels partitioned according to baseline quartiles and in which AF was defined by physician reports or by both Minnesota coding and physician reports. Conclusions: In-treatment SUA is a strong predictor for new-onset AF in hypertensive patients, independent of effects of antihypertensive treatment, age, sex, and ECG-LVH. Further research is needed to clarify how uric acid may provoke AF (ClinicalTrials.gov identifier: NCT00338260).

The role of some additional risk factors in the occurrence of paroxysmal / persistent atrial fibrillation in patients with arterial hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Background Arterial hypertension (AH) and atrial fibrillation (AF) are two important public health problems and often coexist in the same patient. AH ultimately increases the risk of AF and several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. AH is one of the main reasons for the remodeling process in these patients and makes a significant contribution to the development of structural changes. The aim of this study is to identify predictors of paroxysmal/persistent AF occurrence and progression in hypertensive patients Methods In this study where enrolled 109 hypertensive patients with non-valvular paroxysmal/persistent AF (mean age 61.6 ±6.4) who were hospitalized at Institute of Cardiology between 2008 and 2016 year. As a control group, 44 hypertensive patients without AF were also examined. The study lasted 8 years. After the enrollment the echocardiography examination and 24-hour ambulatory Holter monitoring ECG were registered in each patient. We measured plasma indexes of inflammation (hsCRP, IL-6) and fibrosis marker - transforming growth factor (TGF-β1). The database consisting of 33 indicators that characterize the clinical, hemodynamic and structural-functional state of the heart, as well as markers of inflammation and fibrosis was created. .All data were analyzed by SPSS 13 and EXCEL - 2013 programs using logistic analysis by odds ratio (OR). Results The comparative results of clinical, hemodynamic, inflammation and fibrosis markers OR with AF in hypertensive patients relative to the control group showed that in hypertensive patients with AF there was a significant increase in diastolic pressure (OR 1.09, р=0.017) , the number of hypertensive crises episodes ( OR 1.56 р=0.001) and patients of older age groups (OR 1.18, р= 0.001) There was a significant deterioration in electrical remodeling (Pmax 3.92, р=0.001, P dispersion 4.90, р=0.001), LV diastolic function (isometric ventricular contraction time 1.69, р=0.042) and of left atrial volume (OR 3.69, р=0.001). There were significant increases in levels of inflammatory and fibrosis markers concentrations in comported with hypertensive patients without AF (OR of hsСRP 5.57, р=0.01; IL-6 4.80, р=0.001 and TGF-β1 3.84, р=0.005). Conclusions The multifactorial analysis revealed that increased diastolic pressure, frequency of hypertensive crises, age, deterioration of diastolic function, as well as an increase in markers of inflammation and fibrosis concentration are additional risk factors for AF in patients with hypertension.

Screening for atrial fibrillation in hypertensive patients using a mobile application (about 160 cases)

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting between 1 and 4% of the general population and responsible for 10 to 20% of strokes. New technologies are now available for screening for AF, but their implementation in real clinical settings has not yet been fully investigated. The aim of our study is to evaluate the electrocardiogram (ECG) recordings on smartphones intended for screening for AF using the KardiaMobile device (Alivecor), a portable device 5 cm long and 80 g in weight, with a dedicated mobile application. Prospective screening for AF in patients aged 55 or over, known to be hypertensive for at least 5 years, was performed at the cardiology consultation services between June 2019 and July 2020. exclusion from the study. The CHA2DS2-VASc score was collected from each patient. A single lead ECG was acquired by placing the fingers of each hand on the electrodes. The diagnosis of the Kardia app was assessed by the consultation cardiologist, and a baseline ECG was performed for each suspected arrhythmia. A total of 160 ECGs were performed. The diagnosis of the Kardia app was provided in 93% of cases. A heart rhythm described as normal was detected in 120 consultants, in an atrial fibrillation was suspected in 8.1% of the patients described by the device as possible AF, and confirmed by a baseline ECG in 7.5% of the patients screened ( Fig. 1 ). Anti-coagulation was started in 6.2% of patients based on the CHADS-VASC score. The Kardia app is able to quickly filter and detect AF with high sensitivity and specificity. The possible diagnosis of possible AF warrants further cardiological evaluation screening through the use of mHealth technology could be an effective tool in patients at cardiovascular risk for better prevention.