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Data concerning atrial fibrillation (AF) in hypertensive patients are limited, especially in China. Thus, we conducted an observational study to investigate the prevalence and incidence, predictors, and outcome of AF based on Chinese population.
A perspective cohort study was conducted using biennial health examinations of Kailuan Study in northern China through 2006 to 2015. We included 42905 participants who met hypertension criteria at baseline. AF was identified through medical history and 12-ECG electrocardiograms at baseline and biennial follow-up visits (2008-2015). Detailed information on vital status was collected during the whole period. The all-cause of death was acquired from medical insurance database and death certificate. Cox proportional hazards regression models were used to detect independent risk factors of incident AF and calculate multivariable-adjusted hazard ratios for outcome associated with presence of AF.
The baseline prevalence of AF was 0.62% (n=267) and was comparable in men and women (0.65% in men vs. 0.48% in women, P=0.122). During 7.0 ± 2.1 years of follow-up, 221 participants developed AF, with a resulting overall AF incidence of 0.84 per 1,000 person-years. Age, body mass index (BMI), height (HT), low-density lipoprotein cholesterol (LDL-c), chronic kidney disease (CKD), and heart failure (HF), but not gender and anti-hypertensive medication, were independently associated with incident AF. The hazard ratio and 95% confidence of per SD increment of age (HR: 2.44; 95% confidence CI: 2.10-2.82), BMI (HR: 1.28; 95% CI: 1.13-1.45), HT (HR: 1.31; 95% CI: 1.14-1.50), and LDL-c (HR: 0.79; 95% CI: 0.69-0.90) and of CKD (HR: 1.66; 95% CI: 1.23-2.23) and HF (HR: 4.98 95% CI:2.04-12.16). After multivariable adjustment, AF was associated with cerebral infarction (hazard ratio: 2.45; 95% CI: 1.77 to 3.41; p < 0.001), heart failure (HR: 3.42; 95% CI: 2.40 to 4.88; p < 0.001), and all-cause mortality (HR: 2.06; 95% CI: 1.68 to 2.53; p < 0.001). However, no significant association was observed between AF and cerebral hemorrhage and myocardial infarction.
In hypertensive patients, advancing age, high BMI, increasing HT, low level of LDL-c, CKD, and HF were independently associated with high AF risk, and AF would increase risk of all-cause mortality and cardiovascular morbidity, especially heart failure.