Department of Medicine, University of Padua, Padua, Italy.
Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre, University of Leuven, Leuven, Belgium.
Heart. 2018 Aug;104(15):1263-1270. doi: 10.1136/heartjnl-2017-312488. Epub 2018 Feb 9.
Data on the contribution of ambulatory blood pressure (ABP) components to the risk of developing atrial fibrillation (AF) are limited. We prospectively tested the hypothesis that ABP may represent a potentially modifiable risk factor for the development of AF in a European population study.
We recorded daytime blood pressure (BP) in 3956 subjects randomly recruited from the general population in five European countries. Of these participants, 2776 (70.2%) underwent complete 24-hour ABP monitoring. Median follow-up was 14 years. We defined daytime systolic BP load as the percentage BP readings above 135 mm Hg. The incidence of AF was assessed from ECGs obtained at baseline and follow-up and from records held by general practitioners and/or hospitals.
Overall, during 58 810 person-years of follow-up, 143 participants experienced new-onset AF. In adjusted Cox models, each SD increase in baseline 24 hours, daytime and night-time systolic BP was associated with a 27% (P=0.0056), 22% (P=0.023) and 20% (P=0.029) increase in the risk for incident AF, respectively. Conventional systolic BP was borderline associated with the risk of AF (18%; P=0.06). As compared with the average population risk, participants in the lower quartile of daytime systolic BP load (<3%) had a 51% (P=0.0038) lower hazard for incident AF, whereas in the upper quartile (>38%), the risk was 46% higher (P=0.0094).
Systolic ABP is a significant predictor of incident AF in a population-based cohort. We also observed that participants with a daytime systolic BP load >38% had significantly increased risk of incident AF.
关于动态血压（ABP）成分对心房颤动（AF）风险的贡献的数据有限。我们前瞻性地检验了假设，即在欧洲人群研究中，ABP 可能代表 AF 发展的潜在可改变的风险因素。
我们在五个欧洲国家的普通人群中随机招募了 3956 名受试者，记录了他们的日间血压（BP）。其中 2776 名（70.2%）接受了完整的 24 小时 ABP 监测。中位随访时间为 14 年。我们将日间收缩压负荷定义为高于 135mmHg 的血压读数百分比。通过基线和随访时的心电图以及全科医生和/或医院的记录来评估 AF 的发生率。
在总共 58810 人年的随访期间，143 名参与者发生了新发性 AF。在调整后的 Cox 模型中，基线 24 小时、日间和夜间收缩压每增加一个标准差，分别与新发 AF 风险增加 27%（P=0.0056）、22%（P=0.023）和 20%（P=0.029）相关。传统的收缩压与 AF 风险呈临界相关（18%；P=0.06）。与平均人群风险相比，日间收缩压负荷较低四分位（<3%）的参与者新发 AF 的风险降低了 51%（P=0.0038），而上四分位（>38%）的风险则增加了 46%（P=0.0094）。
在基于人群的队列中，收缩压 ABP 是新发 AF 的重要预测因素。我们还观察到，日间收缩压负荷>38%的参与者新发 AF 的风险显著增加。
