Ko Darae, Preis Sarah R, Lubitz Steven A, McManus David D, Vasan Ramachandran S, Hamburg Naomi M, Benjamin Emelia J, Mitchell Gary F
Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
Department of Biostatistics, Boston University School of Public Heath, Boston, Massachusetts; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts.
Am J Cardiol. 2018 Mar 1;121(5):596-601. doi: 10.1016/j.amjcard.2017.11.036. Epub 2017 Dec 11.
Previous studies have reported that orthostatic hypotension (OH) is associated with increased risk of atrial fibrillation (AF). We sought to determine whether the association persists after adjusting for hypertension and other cardiovascular risk factors. We studied the Framingham Heart Study Original cohort participants evaluated between 1981 and 1984 without baseline AF. OH was defined as drop in standing systolic blood pressure (BP) of at least 20 mm Hg or standing diastolic BP of at least 10 mm Hg from their supine values after standing for 2 minutes. We estimated Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HR) for association between OH and risk of incident AF, adjusting for age, sex, seated systolic BP and diastolic BP, resting heart rate, height, weight, current tobacco use, hypertension treatment, diabetes, and history of myocardial infarction and heart failure. Of 1,736 participants (mean age, 71.7 ± 6.5 years, 60% women), 256 (14.8%) had OH at baseline. During 10 years of follow-up, 224 participants developed new AF. In our multivariable-adjusted model, OH (HR 1.61, 95% confidence interval 1.17 to 2.20) and greater orthostatic decrease in mean arterial pressure (MAP) (HR 1.11, 95% confidence interval 1.02 to 1.22 per 8.6 mm Hg change in MAP) were both associated with higher risk of new AF. In conclusion, in our longitudinal community-based sample, OH and orthostatic decline in MAP were significantly associated with increased risk of incident AF after adjustment for systolic BP, diastolic BP, and hypertension treatment.
既往研究报告称，体位性低血压（OH）与心房颤动（AF）风险增加相关。我们试图确定在调整高血压和其他心血管危险因素后，这种关联是否仍然存在。我们研究了1981年至1984年间接受评估、无基线AF的弗雷明汉心脏研究原始队列参与者。OH定义为站立2分钟后，站立收缩压（BP）较仰卧值下降至少20 mmHg或站立舒张压下降至少10 mmHg。我们估计了Cox比例风险回归模型，以计算OH与新发AF风险之间关联的多变量调整风险比（HR），并对年龄、性别、坐位收缩压和舒张压、静息心率、身高、体重、当前吸烟情况、高血压治疗、糖尿病以及心肌梗死和心力衰竭病史进行了调整。在1736名参与者（平均年龄71.7±6.5岁，60%为女性）中，256名（14.8%）在基线时患有OH。在10年的随访期间，224名参与者发生了新发AF。在我们的多变量调整模型中，OH（HR 1.61，95%置信区间1.17至2.20）和平均动脉压（MAP）更大的体位性下降（每8.6 mmHg MAP变化，HR 1.11，95%置信区间1.02至1.22）均与新发AF的较高风险相关。总之，在我们基于社区的纵向样本中，在调整收缩压、舒张压和高血压治疗后，OH和MAP的体位性下降与新发AF风险增加显著相关。
