Larstorp Anne C K, Stokke Ildri M, Kjeldsen Sverre E, Hecht Olsen Michael, Okin Peter M, Devereux Richard B, Wachtell Kristian
Departments of Medical Biochemistry and Cardiology, Oslo University Hospital, University of Oslo , Oslo , Norway.
Department of Internal Medicine, Holbaek Hospital, and Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital , Odense , Denmark.
Blood Press. 2019 Oct;28(5):317-326. doi: 10.1080/08037051.2019.1633905. Epub 2019 Jul 1.
Atrial fibrillation (AF) is associated with increased cardiovascular risk and the incidence increases with age, hypertension and left ventricular hypertrophy (LVH). Reducing in-treatment systolic blood pressure (SBP) prevents new-onset AF but has previously not been studied in patients with isolated systolic hypertension (ISH). We aimed to investigate the effect on preventing new-onset AF by decreased in-treatment SBP in patients with ISH compared to patients with non-ISH. Double-blind, randomized, parallel-group study of 1320 patients with ISH and electrocardiographic (ECG) LVH, included among the 9193 patients in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Annual ECGs were Minnesota coded centrally, and new-onset AF was evaluated in 1248 ISH patients and compared with 7583 non-ISH patients during mean 4.8 ± 0.9 years follow-up. Cox regression analyses were used to assess the effect of reduced in-treatment SBP. New-onset AF occurred in 61 (4.9%) ISH patients and 292 (3.9%) non-ISH patients. In multivariate analysis lower in-treatment SBP was associated with 17% risk reduction ( = 0.008) for new-onset AF in ISH patients and 9% risk reduction ( = 0.006) in non-ISH patients per 10 mmHg decrease in in-treatment SBP, independent of treatment modality, baseline risk factors, baseline SBP and in-treatment heart rate and ECG-LVH. There was a significant interaction ( = 0.041) in favor of SBP reduction and AF prevention in ISH vs. non-ISH patients. Our data suggest that the effect of in-treatment SBP reduction in preventing new-onset AF is stronger in ISH compared to non-ISH patients with hypertension and ECG-LVH. However, the principal findings were the same in ISH and non-ISH patients.
心房颤动（AF）与心血管风险增加相关，其发病率随年龄、高血压和左心室肥厚（LVH）而升高。降低治疗期间的收缩压（SBP）可预防新发房颤，但此前尚未在单纯收缩期高血压（ISH）患者中进行研究。我们旨在研究与非ISH患者相比，降低ISH患者治疗期间的SBP对预防新发房颤的效果。对1320例ISH且有心电图（ECG）左心室肥厚的患者进行双盲、随机、平行组研究，这些患者纳入了氯沙坦干预降低高血压终点事件（LIFE）研究的9193例患者之中。每年的心电图由明尼苏达中心编码，在平均4.8±0.9年的随访期间，对1248例ISH患者的新发房颤进行评估，并与7583例非ISH患者进行比较。采用Cox回归分析评估降低治疗期间SBP的效果。61例（4.9%）ISH患者和292例（3.9%）非ISH患者发生新发房颤。在多变量分析中，治疗期间SBP每降低10 mmHg，ISH患者新发房颤的风险降低17%（P=0.008），非ISH患者降低9%（P=0.006），与治疗方式、基线风险因素、基线SBP、治疗期间心率和心电图左心室肥厚无关。ISH与非ISH患者在SBP降低和房颤预防方面存在显著交互作用（P=0.041）。我们的数据表明，与有高血压和心电图左心室肥厚的非ISH患者相比，降低ISH患者治疗期间的SBP预防新发房颤的效果更强。然而，ISH和非ISH患者的主要研究结果是相同的。
