Lower Syst Blood Pressure Lessens AF Risk in Hypertensive Patients.

[Argirios Argiriou]

Lower Systolic Blood Pressure Lessens Atrial Fibrillation Risk in Hypertensive Patients.

August 26, 2015

Joel M. Gore, MD reviewing Okin PM et al. Hypertension 2015 Aug.

Achieving SBP <130 mm Hg was associated with a 40% lower risk for new-onset AF in a reanalysis of study clinical data.

The incidence of atrial fibrillation (AF) is higher among patients with hypertension and is related to the severity of hypertension. In a substudy of LIFE, an industry-funded treatment-comparison study (NEJM JW Cardiology Feb 2005 and JAMA 2004; 292:2343), researchers evaluated whether achievement of lower systolic blood pressure (SBP) during treatment of hypertension would be associated with a decreased risk for new-onset AF.

The 8831 hypertensive participants had electrocardiographic (ECG) evidence of left ventricular hypertrophy and no history or baseline ECG of AF. During follow-up (mean, 4.6 years), 701 patients experienced new-onset AF (7.9%). These patients were older than non-AF patients; more likely to be male and nonblack and to have histories of ischemic heart disease, myocardial infarction, stroke, and heart failure; more likely to have lower total cholesterol levels and greater albuminuria; and less likely to have been randomized to losartan.

In-treatment-achieved SBP values were classified as lower (<130 mm Hg), typical (131–141 mm Hg), and less-adequate (≥142 mm Hg). In multivariate analyses that adjusted for treatment randomization and cardiovascular factors, both lower- and typical-achieved SBP values were associated with statistically significant lower risk for new-onset AF. Compared with less-adequate-achieved SBP values, typical-achieved values were associated with a 24% reduction in new-onset AF risk; for lower-achieved values, the reduction in risk was 40%.

Comment

In this retrospective analysis of LIFE trial data, reduction of blood pressure in hypertensive patients was associated with a decreased risk for new-onset AF, and more aggressive control additionally reduced the risk. Further study is required to determine whether lowering BP goals in hypertensive patients without AF reduces the consequent burdens imposed by AF. For clinicians aiming to achieve optimal BP control, the goal of “lower is better” is strengthened in that one may be lowering the risk for atrial fibrillation.

Editor Disclosures at Time of Publication

    Disclosures for Joel M. Gore, MD at time of publication Grant / Research support NIH-NHLBI

Citation(s):

    Okin PM et al. Effect of lower on-treatment systolic blood pressure on the risk of atrial fibrillation in hypertensive patients. Hypertension 2015 Aug; 66:368. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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