Haywood L Julian, Ford Charles E, Crow Richard S, Davis Barry R, Massie Barry M, Einhorn Paula T, Williard Angela
Los Angeles County/University of Southern California Medical Center, Los Angeles, California, USA.
J Am Coll Cardiol. 2009 Nov 24;54(22):2023-31. doi: 10.1016/j.jacc.2009.08.020.
The ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) determined that treatment with amlodipine, lisinopril, or doxazosin was not superior to thiazide-like diuretic (chlorthalidone) in preventing coronary heart disease (CHD) or other cardiovascular events. This subanalysis examines baseline prevalence and in-trial incidence of new-onset atrial fibrillation (AF) or atrial flutter (AFL) and their influence on clinical outcomes.
Limited information is available on whether atrial fibrillation incidence is affected differentially by different classes of antihypertensive medications or treatment with statins.
AF/AFL was identified from baseline and follow-up electrocardiograms performed biannually. Analyses were performed to identify characteristics associated with baseline AF/AFL and its subsequent incidence.
AF/AFL was present at baseline in 423 participants (1.1%), more frequent in men (odds ratio: 1.72; 95% confidence interval [CI]: 1.37 to 2.17) and nonblacks (odds ratio: 2.09; 95% CI: 1.58 to 2.75). Its prevalence increased with age (p < 0.001) and was associated with CHD, cardiovascular disease, obesity, and high-density lipoprotein cholesterol <35 mg/dl. New-onset AF/AFL was associated with the same baseline risk factors plus electrocardiogram left ventricular hypertrophy. It occurred in 641 participants (2.0%) and, excluding doxazosin, did not differ by antihypertensive treatment group or, in a subset of participants, by pravastatin versus usual care. Baseline AF/AFL was associated with increased mortality (hazard ratio [HR]: 2.82; 95% CI: 2.36 to 3.37; p < 0.001), stroke (HR: 3.63; 95% CI: 2.72 to 4.86; p < 0.001), heart failure (HR: 3.17; 95% CI: 2.38 to 4.25; p < 0.001), and fatal CHD or nonfatal myocardial infarction (HR: 1.64; 95% CI: 1.22 to 2.21; p < 0.01). There was a nearly 2.5-fold increase in mortality risk when AF/AFL was present at baseline or developed during the trial (HR: 2.42; 95% CI: 2.11 to 2.77; p < 0.001).
In this high-risk hypertensive population, pre-existing and new-onset AF/AFL were associated with increased mortality. Excluding doxazosin, treatment assignment to either antihypertensive drugs or pravastatin versus usual care did not affect AF/AFL incidence. (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial [ALLHAT]; NCT00000542).
抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）确定，氨氯地平、赖诺普利或多沙唑嗪在预防冠心病（CHD）或其他心血管事件方面并不优于噻嗪类利尿剂（氯噻酮）。本亚组分析研究了新发心房颤动（AF）或心房扑动（AFL）的基线患病率和试验期间发病率及其对临床结局的影响。
关于不同类别的抗高血压药物或他汀类药物治疗对心房颤动发病率的影响，目前可用信息有限。
通过每半年进行一次的基线和随访心电图确定AF/AFL。进行分析以确定与基线AF/AFL及其后续发病率相关的特征。
423名参与者（1.1%）基线时存在AF/AFL，男性更常见（比值比：1.72；95%置信区间[CI]：1.37至2.17），非黑人更常见（比值比：2.09；95%CI：1.58至2.75）。其患病率随年龄增加而升高（p<0.001），并与冠心病、心血管疾病、肥胖以及高密度脂蛋白胆固醇<35mg/dl相关。新发AF/AFL与相同的基线危险因素以及心电图左心室肥厚相关。641名参与者（2.0%）发生了新发AF/AFL，排除多沙唑嗪后，抗高血压治疗组之间无差异，在一部分参与者中，普伐他汀与常规治疗之间也无差异。基线AF/AFL与死亡率增加相关（风险比[HR]：2.82；95%CI：2.36至3.37；p<0.001）、中风（HR：3.63；95%CI：2.72至4.86；p<0.001）、心力衰竭（HR：3.17；95%CI：2.38至4.25；p<0.001）以及致命性CHD或非致命性心肌梗死（HR：1.64；95%CI：1.22至2.21；p<0.01）。当基线时存在AF/AFL或在试验期间发生时，死亡风险增加近2.5倍（HR：2.42；95%CI：2.11至2.77；p<0.001）。
在这个高危高血压人群中，既往存在的和新发的AF/AFL与死亡率增加相关。排除多沙唑嗪后，抗高血压药物或普伐他汀与常规治疗的治疗分配不影响AF/AFL发病率。（抗高血压和降脂治疗预防心脏病发作试验[ALLHAT]；NCT00000542）
