Department of Hypertension, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China.
Am J Hypertens. 2019 Jul 17;32(8):777-785. doi: 10.1093/ajh/hpz060.
Atrial fibrillation (AF) and hypertension are prevalent chronic disease conditions in the elderly population. In the present cross-sectional study, we investigated the association between blood pressure (BP) and AF in an elderly Chinese population.
Our elderly (≥65 years) subjects were residents recruited from 6 communities in Shanghai from 2006 to 2017. Atrial fibrillation was systematically screened by rest 12-lead electrocardiogram (ECG) or by a handheld single-lead ECG. BP status was defined according to the European hypertension guidelines as optimal, normal, or high-normal BP, and stage 1, 2, or 3 hypertension.
In the 6,966 participants (women 56.0%, mean age: 72.3 years), the prevalence of AF was 3.3%, and the prevalence of hypertension was 58.7% (83.7% treated). In all participants, the association with prevalent AF was negative for systolic BP (odds ratio [OR] per 10-mm Hg increase 0.79, 95% confidence interval [CI]: 0.71-0.88, P < 0.0001) but positive for diastolic BP (OR per 5-mm Hg increase 1.11, 95% CI: 1.02-1.22, P = 0.02). In untreated participants (n = 3,544), the association with prevalent AF was U-shaped for both systolic and diastolic BP, with the nadir at high-normal BP and a significantly higher risk of prevalent AF in optimal systolic BP (OR: 3.11, 95% CI: 1.65-5.85, P = 0.004) and stage 2 or 3 diastolic hypertension relative to the nadir (OR: 8.04, 95% CI: 2.28-28.3, P = 0.001).
In the elderly population, BP shows a complicated relationship with prevalent AF, with high-normal BP at the lowest risk and optimal systolic BP and stage 2 or 3 diastolic hypertension at increased risks.
心房颤动（AF）和高血压是老年人群中常见的慢性疾病。在本横断面研究中，我们调查了血压（BP）与老年中国人群 AF 之间的关系。
我们的老年（≥65 岁）受试者是 2006 年至 2017 年从上海 6 个社区招募的居民。通过静息 12 导联心电图（ECG）或手持单导联 ECG 系统筛查 AF。BP 状况根据欧洲高血压指南定义为最佳、正常或正常高值血压，以及 1 期、2 期或 3 期高血压。
在 6966 名参与者（女性 56.0%，平均年龄：72.3 岁）中，AF 的患病率为 3.3%，高血压的患病率为 58.7%（83.7%接受治疗）。在所有参与者中，收缩压与 AF 患病率呈负相关（每增加 10mmHg 的比值比 [OR]为 0.79，95%置信区间 [CI]：0.71-0.88，P<0.0001），但舒张压呈正相关（每增加 5mmHg 的 OR 为 1.11，95%CI：1.02-1.22，P=0.02）。在未经治疗的参与者（n=3544）中，收缩压和舒张压与 AF 患病率呈 U 型相关，最佳收缩压的 AF 患病率明显更高（OR：3.11，95%CI：1.65-5.85，P=0.004），与收缩压最佳时相比，收缩压或 3 期高血压的 AF 患病率更高（OR：8.04，95%CI：2.28-28.3，P=0.001）。
在老年人群中，BP 与 AF 之间呈复杂关系，正常高值 BP 的风险最低，最佳收缩压和 2 期或 3 期舒张压高血压的风险增加。
