Ariansen Inger, Reims Henrik M, Gjesdal Knut, Olsen Michael Hecht, Ibsen Hans, Devereux Richard B, Okin Peter M, Kjeldsen Sverre E, Dahlöf Björn, Wachtell Kristian
Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.
Blood Press. 2012 Feb;21(1):6-11. doi: 10.3109/08037051.2011.622978. Epub 2011 Nov 10.
The incidence of new-onset atrial fibrillation (AF) is increased by uncontrolled hypertension, and antihypertensive treatment reduces new-onset AF. However, it is unclear whether alcohol intake and smoking influence the risk of new-onset AF during antihypertensive treatment.
In the Losartan Intervention For Endpoint reduction in Hypertension (LIFE) study, a double-blinded, randomized, parallel-group study, 9193 hypertensive patients with electrocardiogram (ECG)-documented left ventricular hypertrophy (LVH), randomized to once-daily losartan- or atenolol-based antihypertensive therapy were followed for a mean of 4.8 years. At baseline, 8831 patients (54% women, mean age 67 years, mean blood pressure 174/98 mmHg after placebo run-in) had neither a history of AF nor AF on ECG, and they were thus at risk of developing this condition during the study.
New-onset AF occurred in 353 (4%) patients. Univariate Cox analyses showed that intake of alcohol > 10 units/week compared with less or no alcohol intake predicted new-onset AF (Hazard ratio, HR = 1.60 [95% CI 1.02-2.51], p = 0.043). Multivariate Cox regression analysis showed that intake of alcohol > 10 units/week predicted new-onset AF (p = 0.010) independently of most other univariate predictors, except when also baseline serum cholesterol, serum potassium and urinary albumin/creatinine ratio were included in the model (HR = 1.60 [95% CI 0.94-2.72], p = 0.081). Impact of smoking was not significant in Cox univariate or multivariate analyses, and there were no significant interactions between high alcohol intake and either smoking or gender on the risk of getting AF.
Up to 10 drinks of alcohol per week appears to be safe with respect to the risk for AF in hypertensive patients with LVH. Our data suggest that alcohol intake above this level may be marginally deleterious, while no effect of smoking on risk of AF was detected in hypertensive patients with LVH.
血压控制不佳会增加新发房颤（AF）的发生率，而降压治疗可降低新发房颤的发生率。然而，饮酒和吸烟是否会影响降压治疗期间新发房颤的风险尚不清楚。
在氯沙坦干预降低高血压终点事件（LIFE）研究中，这是一项双盲、随机、平行组研究，9193例有心电图（ECG）记录的左心室肥厚（LVH）的高血压患者，随机接受每日一次的氯沙坦或阿替洛尔为基础的降压治疗，平均随访4.8年。基线时，8831例患者（54%为女性，平均年龄67岁，安慰剂导入后平均血压174/98 mmHg）既无房颤病史，ECG也未显示房颤，因此在研究期间有发生这种疾病的风险。
353例（4%）患者发生新发房颤。单因素Cox分析显示，每周饮酒超过10单位与较少或不饮酒相比，可预测新发房颤（风险比，HR = 1.60 [95% CI 1.02 - 2.51]，p = 0.043）。多因素Cox回归分析显示，每周饮酒超过10单位可独立于大多数其他单因素预测因素预测新发房颤（p = 0.010），除非模型中同时纳入基线血清胆固醇、血清钾和尿白蛋白/肌酐比值（HR = 1.60 [95% CI 0.94 - 2.72]，p = 0.081）。在Cox单因素或多因素分析中，吸烟的影响不显著，高酒精摄入量与吸烟或性别之间在发生房颤的风险上没有显著的相互作用。
对于LVH高血压患者，每周饮酒多达10杯似乎对房颤风险是安全的。我们的数据表明，超过这个水平的酒精摄入可能有轻微危害，而在LVH高血压患者中未检测到吸烟对房颤风险有影响。
