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.

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.

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.
 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.
 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.
 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.

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.

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.

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.

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.

Role of epicardial adipose tissue in the development of atrial fibrillation in hypertensive patients

Obesity is a progressing epidemic, the prevalence of which has doubled over the past 30 years. The distribution of adipose tissue is an important factor in predicting the risk of cardiovascular events. The most significant inflammatory activity is characteristic of epicardial adipose tissue (EAT), the role of which in the development of atrial fibrillation (AF) remains a subject of discussion.Aim. To study the effect of EAT size on the development of AF in hypertensive (HTN) patients.Material and methods. The study included 95 patients with HTN aged 38-72 years (mean age, 61,5±1,8 years), including 45 patients with paroxysmal AF (group I) and 50 patients in the comparison group (group II). In order to assess the severity of visceral obesity, all patients underwent a general examination and echocardiography. To determine the EAT volume, cardiac multislice computed tomography was performed.Results. Echocardiography revealed that the EAT thickness was significantly greater in hypertensive patients with paroxysmal AF than in the comparison group: 11,6±0,8 and 8,6±0,4 mm, respectively (p&lt;0,001). According to cardiac multislice computed tomography, a significant increase in EAT volume was revealed in patients of group I (4,6±0,4 ml) compared with group II (3,5±0,25 ml) (p=0,019). In hypertensive patients with paroxysmal AF, a positive moderate relationship between the EAT volume and left atrial volume was revealed (r=0,7, p=0,022). Multivariate analysis showed that in hypertensive patients, EAT thickness &gt;10 mm and volume &gt;6 ml can serve as integral markers of the onset of paroxysmal AF.Conclusion. Integral markers of AF in hypertensive patients are an increase in the EAT thickness &gt;10 mm (odds ratio, 4,1; 95% confidence interval, 1,1-5,6) and volume &gt;6 ml (odds ratio 3,7; 95%, confidence interval 1,0-4,2).

Heat Shock Protein 70 Is Associated With Cardioversion Outcome and Recurrence of Symptomatic Recent Onset Atrial Fibrillation in Hypertensive Patients.

Accumulating evidence indicates that heat shock proteins (HSPs) may represent a suitable biomarker to predict atrial fibrillation (AF). We investigated the relation of circulating serum HSP70 (sHSP70) with inflammatory cytokines and recurrence of symptomatic recent onset AF (ROAF). We enrolled 90 patients with ROAF (the duration from onset of symptoms ≤24 hours) and 30 controls. Patients received amiodarone for cardioversion and rhythm control. The association of serum HSP70, serum interleukin-2 (sIL-2), and serum interleukin-4 (sIL-4) with the presence of cardioversion and AF recurrence within a year was investigated. Toll-like receptor 4 (TLR4) signaling dependence for IL-2 and IL-4 induction in response to stimulation with HSP70 was tested in rat aortic vascular smooth muscle cell cultures. Patients had higher sHSP70 and sIL-2 and lower sIL-4 compared with controls. Serum HSP70 was independently associated with ROAF (P = 0.005) and correlated with sIL-2 (r = 0.494, P < 0.001) and sIL-4 (r = -0.550, P < 0.001). By 48 hours, 71 of the 90 patients were cardioverted, with noncardioverted patients having higher sHSP70 and sIL-2 and lower sIL-4, which were the only independent factors associated with cardioversion. AF recurred in 38 of the 71 cardioverted patients in 1 year. A cutoff value of sHSP70 ≥0.65 ng/mL and sIL-2 ≥0.21 pg/mL was the only independent factor associated with AF recurrence (hazard ratio: 3.311, 95% confidence interval: 1.503-7.293, P = 0.003 and hazard ratio: 3.144, 95% confidence interval: 1.341-7.374, P = 0.008, respectively). The exposure of smooth muscle cell to HSP70 in vitro increased the expression of IL-2 (5×) and IL-4 (1.5×) through TLR4-dependent and receptor-independent mechanisms. In conclusion, sHSP70 and sIL-2 might constitute a prognostic tool for determining the cardioversion and recurrence likelihood in ROAF.

Relationship between red blood cell distribution width levels and atrial fibrillation in hypertensive patients.

BackgroundInformation on the relationship between red blood cell distribution width (RDW) and atrial fibrillation (AF) in patients with essential hypertension are scarce. The study aimed to assess the relationship between AF and RDW in hypertensive patients.MethodsWe enrolled 432 hypertensive patients, including 350 AF patients and 82 patients as controls. Patients' demographic, clinical, laboratory and echocardiographic characteristics were recorded. The AF patients were further divided into the persistent and paroxysmal AF subgroups. Electrocardiograms were monitored to identify the cardiac rhythm during blood sampling, and based on the rhythm, the paroxysmal AF group was categorized into the presence (with AF rhythm during blood sampling) and absence (with sinus rhythm during blood sampling) groups.ResultsThe AF group had elevated RDW levels than the controls (12.7% ± 0.8% vs. 12.4% ± 0.7%, P = 0.002), and the persistent AF subgroup had higher RDW levels than the paroxysmal AF subgroup (12.9% ± 0.8% vs. 12.6% ± 0.8%, P = 0.007). Furthermore, in the paroxysmal AF group, the presence group had higher RDW levels than the absence group (13.0% ± 0.6% vs. 12.5% ± 0.9%, P = 0.001). There was no significant difference in RDW levels between the persistent AF subgroup and presence group of the paroxysmal AF subgroup (P = 0.533) and between the absence group of the paroxysmal AF subgroup and control group (P = 0.262). In multivariate regression analysis, in hypertensive patients, the presence of AF rhythm is an independent predictor for increased RDW concentration (P = 0.001).ConclusionsThe RDW may be associated with the presence of AF rhythm, which implies the importance of maintaining the sinus rhythm in hypertensive patients.

On-treatment HDL cholesterol predicts incident atrial fibrillation in hypertensive patients with left ventricular hypertrophy

Purpose: Hypertensive patients are at increased risk of atrial fibrillation (AF). Although low baseline high density lipoprotein (HDL) cholesterol has been associated with a higher risk of AF, this has not been verified in recent population-based studies. Whether changing levels of HDL over time are more strongly related to the risk of new AF in hypertensive patients has not been examined.Material and methods: Incident AF was examined in relation to baseline and on-treatment HDL levels in 8267 hypertensive patients with no history of AF, in sinus rhythm on their baseline electrocardiogram, randomly assigned to losartan- or atenolol-based treatment. HDL levels at baseline and each year of testing were categorised into quartiles according to baseline HDL levels.Results: During 4.7 ± 1.10 years of follow-up, 645 patients (7.8%) developed new AF. In univariate Cox analyses, compared with the highest quartile of HDL levels (>1.78 mmol/l), patients with on-treatment HDL in the lowest quartile (≤ 1.21 mmol/l) had a 53% greater risk of new AF. Patients with on-treatment HDL in the second and third quartiles had intermediate increased risks of AF. Baseline HDL in the lowest quartile was not a significant predictor of new AF (hazard ratio (HR): 1.14, 95% confidence interval (CI): 0.90–1.43). In multivariable Cox analyses adjusting for multiple baseline and time-varying covariates, the lowest quartile of on-treatment HDL remained associated with a nearly 54% increased risk of new AF (HR: 1.54, 95% CI: 1.16–2.05) whereas a baseline HDL≤ ⩽1.21 mmol/l was not predictive of new AF (HR: 1.01, 95% CI: 0.78–1.31).Conclusion: Lower on-treatment HDL is strongly associated with risk of new AF. These findings suggest that serial assessment of HDL can estimate AF risk better than baseline HDL in hypertensive patients with left ventricular hypertrophy. Future studies may investigate whether therapies that increase HDL can lower risk of developing AF.Clinical Trials Registration: http://clinicaltrials.gov/ct/show/NCT00338260?order=1

GW29-e0084 The prevalence and correlative factors of atrial fibrillation in hypertensive patients: a single-center retrospective study.

GW29-e0084 The prevalence and correlative factors of atrial fibrillation in hypertensive patients: a single-center retrospective study.

6169Combination therapy with renin-angiotensin system inhibitors and statins is associated with reduced incidence of new-onset atrial fibrillation in hypertensive patients

6169Combination therapy with renin-angiotensin system inhibitors and statins is associated with reduced incidence of new-onset atrial fibrillation in hypertensive patients

LEFT AND RIGHT ATRIAL FUNCTION AND DIMENSION - MARKERS OF PAROXYSMAL ATRIAL FIBRILLATION IN HYPERTENSIVES

Objective: Introduction: Hypertension increases the risk for atrial fibrillation and is the most common underlying risk factor for the development of atrial fibrillation (1). Discovering predictors for the onset of atrial fibrillation in hypertensives may have prognostic value. Objective: We evaluated left atrium (LA) and right atrium (RA) dimension and function in our attempt to find an echocardiographic marker of paroxysmal atrial fibrillation in hypertensive patients without other significant heart disease.Design and method: Methods: We prospectively enrolled three groups of patients: 21 heathy patients (Group 1); 42 hypertensive patients without paroxysmal atrial fibrillation (Group 2) and 22 hypertensive patients with paroxysmal atrial fibrillation (Group 3) Secondary causes of HTN and other coexistent severe pathology were excluded. LA and RA diameters and volumes were measured by echocardiography, using modified Simpson biplane method. Peak longitudinal strain of LA and RA walls were analyzed using 2D speckle-tracking echocardiography. We also measured the LV mass using the M-mode method, but also area-length method. Results: LA and RA diameters, as well as all the volumes were significantly greater in hypertensive groups compared to controls (p < 0.001). There was found a significant difference between peak LA and RA longitudinal strain parameters in the three groups, with the lowest values in Group 3 (p < 0.001). There was also found a significant difference of LV mass between the three groups (p < 0.001); the highest values of the LV mass are found in the patients with hypertension and atrial fibrillation (p < 0.001, R = 0.453) A strong negative correlation between LV linear mass/BSA and LA PALS (peak atrial longitudinal strain) was determined (p = 0.003, R = -0.645) which means that patients with LV linear mass/BSA at high values have also low values of LA PALS in group with atrial fibrillation compared with the other 2 groups. Conclusions: In our study hypertension was associated with structural and functional remodeling of both LA and RA. So, speckle tracking methods and volumes applied for both atria can be successfully used in identifying hypertensive patients with LA and RA dysfunction at high risk to develop atrial fibrillation.

The micro-albuminuria is a new predictor of atrial fibrillation in hypertensive patients

BackgroundHypertension increases the risk of atrial fibrillation by about twofold. Micro-albuminuria is an independent predictor of cardiovascular morbidity and mortality in patients with atrial fibrillation. Aim of the workThe aim of this work was to investigate the relationship between micro-albuminuria 1 (MAU) and occurrence of atrial fibrillation in patients with arterial hypertension. Patients and methodsOur study was conducted in Cardiology Department, Zagazig University. We recruited 300 consecutive patients with newly diagnosed hypertension from outpatient clinics. In this prospective study, we checked for micro-albuminuria (MAU) 1 at presentation. Then a follow up for 6 months to all cases to elicit any documented attack(s) of paroxysmal or persistent atrial fibrillation. Then patients were classified according to development of AF into Group I (patients who did not develop AF during 6 months after diagnosis of hypertension) (230 patients) and Group II (patients who developed AF during 6 months after diagnosis of hypertension) (70 patients). ResultsThe micro-albuminuria was the strongest predictor to develop AF in our cases as the upper and lower “confidence interval” CI was (0.138–0.014) with high significant difference (p<0.001), odds ratio=0.051. Systolic blood pressure, diastolic blood pressure and heart rate were significant (p<0.05) but less powerful than micro-albuminuria to predict the occurrence of AF. ConclusionMicro-albuminuria was the strongest predictor of AF in hypertensive patients. Recommendation and clinical implicationsThe early detection and treatment of micro-albuminuria is accompanied by an improved cardiovascular prognosis in hypertensive patients and prevent new onset of atrial fibrillation.

Antihypertensive control and new-onset atrial fibrillation: Results from the Swedish Primary Care Cardiovascular Database (SPCCD).

Background Atrial fibrillation is associated with increased cardiovascular morbidity and mortality. Hypertension is an important risk factor for the development of atrial fibrillation. Aim This study assessed the relationship between blood pressure control and new-onset atrial fibrillation in hypertensive patients. Methods and results We followed 45,530 hypertensive patients with no previously documented atrial fibrillation, attending primary healthcare in Sweden during 2001-2008. After a mean follow-up of 3.5 years 2057 patients (4.5%) developed atrial fibrillation. Compared to patients with no atrial fibrillation, the new-onset atrial fibrillation group (after adjustment for age, sex, diabetes mellitus, heart failure, ischaemic heart disease, cerebrovascular disease and number of visits) had higher mean in-treatment systolic blood pressure (SBP) and diastolic blood pressure of 3.8 mmHg (95% confidence interval (CI) 3.0-4.6; P < 0.0001) and 1.6 mmHg (95% CI 1.2-2.0; P < 0.0001), respectively. Similarly, mean in-treatment pulse pressure in the new-onset atrial fibrillation group was 2.2 mmHg (95% CI 1.6-2.9; P < 0.001) higher. In a logistic regression analysis, achieved SBP ≥ 140 mmHg was associated with a higher risk of new-onset atrial fibrillation, compared to SBP 130-139 mmHg (odds ratio (OR) 1.5; 95% CI 1.3-1.7) and to SBP < 130 mmHg (OR 1.3; 95% CI 1.1-1.5). There was no difference in risk for new-onset AF between SBP 130-139 and <130 mmHg (OR 0.9; 95% CI 0.7-1.1). Conclusion The present findings indicate that blood pressure control in hypertension is associated with a lower risk of new-onset atrial fibrillation.