Author + information
- Dimitris Konstantinidis,
- Konstantinos Tsioufis,
- Kyriakos Dimitriadis,
- Dimitris Tsiachris,
- Alexandros Kasiakogias,
- Velissaris Antonakis,
- E. Andrikou,
- Dimitrios Aragianis and
- Dimitrios Tousoulis
Background: Evidence suggest that new-onset atrial fibrillation (AF) in hypertensives, is related with organ damage and blood pressure control patterns. The purpose was to compare the predictive role of hypertension related organ damage and blood pressure control patterns for the incidence of new-onset atrial fibrillation.
Methods: We studied 2,280 hypertensive patients (aged 57.7±11 years, 50% males) without history of AF episodes for a median period of 3.3 years (IQR 2.3-5 years). All subjects had at least one visit annually and at entry underwent complete echocardiographic study and additional workup for exclusion of secondary causes of resistant hypertension (RH). Four groups were identified depending on presence or absence of RH (office-based uncontrolled hypertension under at least 3 drugs including a diuretic or controlled hypertension under 4 or more drugs) at baseline and follow-up: 1,494 patients (65.7%) never having RH, 185 (8.1%) with resolved RH, 230 (10.1%) with incident RH and 365 (16.1%) with persistent RH. Endpoint of interest was new-onset AF.
Results: The incidence rate of new-onset AF over the whole follow-up period was 7.06/1000 persons-years. In the univariate analysis age (HR=1.08, p<0.001), office pulse pressure (HR=1.02, p=0.003), duration of hypertension (HR=1.03, p=0.011), left ventricular mass index (HR=1.02, p<0.001), left atrium diameter (HR=3.27, p<0.001), E/Em (HR=1.09, p<0.001), creatinine clearance (HR=0.98, p=0.002), resolved RH (HR=2.65, p=0.009) and persistent RH (HR=1.97, p=0.036) were predictors of new-onset AF. Multivariate Cox regression analysis revealed that age (HR 1.07, p<0.001) and LAD (HR 2.67, p=0.001) turned out to be the only independent predictors of new-onset AF while resolved RH just lost statistical significance (HR 2.00, p=0.09). Based on ROC analysis LAD>39 mm predicted new-onset AF with sensitivity 76.5% and specificity 56.7%.
Conclusions: Hypertensives with new-onset AF are characterized by a greater prevalence of cardiorenal adaptations and a longer and unfavorable patent of hypertension control. However, only older age and enlarged LA size turned out to predict new-onset AF in the setting of essential hypertension.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Toward Precision Medicine in the Treatment of Elevated Blood Pressure
Abstract Category: 33. Prevention: Hypertension
Presentation Number: 1186-040
- 2017 American College of Cardiology Foundation