Author + information
- S0735109716004848-e8d50b1bcbb0ba46b24c8343ba9cd5d0Rob A. Vermond, MD,
- S0735109716004848-e69a9b3695e52f96d3a5a91c2a8a071aBastiaan Geelhoed, PhD and
- S0735109716004848-4b28cce0deaf40ce38b1734606cf9c39Michiel Rienstra, MD, PhD∗ ()
- ↵∗Department of Cardiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
We greatly appreciate the interest of Dr. Onat and colleagues in our paper on risk factors for atrial fibrillation (AF) with cardiovascular outcomes in a contemporary population in the Netherlands (1). Onat and associates discuss whether the association of antihypertensive treatment with higher incidence of AF found in our study may be a paradoxical finding.
Hypertension and blood pressure are probably the most thoroughly studied and best-established risk factors for cardiovascular diseases, in particular AF (2,3). Abundant evidence is available that treating hypertension with antihypertensive medication is beneficial to reduce cardiovascular disease (2). In our PREVEND (Prevention of Renal and Vascular End-Stage Disease) analysis, we studied risk factors of incident AF and found some well-established risk factors (advancing age, male sex, antihypertensive drug use, previous myocardial infarction) and a less clearly established risk factor (obesity). We indeed focused most in our discussion on the less clearly established risk factor: obesity. Hypertension was defined as systolic blood pressure >140 mm Hg, diastolic blood pressure >90 mm Hg, or use of antihypertensive drugs, at the screening visit. Data on antihypertensive drugs were collected from community pharmacy records. When building our regression models, we investigated the relatedness of the covariates of interest. As expected, antihypertensive treatment was strongly and positively correlated with higher blood pressure (≥140/90 mm Hg, without considering antihypertensive treatment), with a correlation coefficient of +0.28. Moreover, antihypertensive treatment was strongly related to both diastolic blood pressure (correlation coefficient +0.22) and systolic blood pressure (correlation coefficient +0.30). We decided that antihypertensive treatment was the most reliable representative of hypertension in the PREVEND study. Antihypertensive treatment was also used as representative of hypertension in publications of the Framingham Heart Study on AF (4). Our results were therefore in accordance with older data from the Framingham Heart Study. Optimal treatment of hypertension and other underlying diseases and promotion of a healthy life-style seem essential in the treatment of AF (5).
Recently, inclusion was finished for the RACE 3 (Routine Versus Aggressive Upstream Rhythm Control for Prevention of Early Atrial Fibrillation in Heart Failure) study, which applies upstream therapies and life-style modifications to improve outcome in AF (5). The results can be expected in early 2017.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Vermond R.A.,
- Geelhoed B.,
- Verweij N.,
- et al.
- Kirchhof P.,
- Lip G.Y.,
- Van Gelder I.C.,
- et al.