Mankoo Alex S, Minhas Jatinder S, Coles Briana, Hussain Shazia T, Khunti Kamlesh, Robinson Thompson G, Mistri Amit K, Eveson David J
Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, Sir Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, LE2 7LX, UK.
National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
High Blood Press Cardiovasc Prev. 2020 Feb;27(1):93-101. doi: 10.1007/s40292-020-00363-4. Epub 2020 Feb 11.
Orthostatic hypotension (OH) and atrial fibrillation (AF) are both regarded as independent risk factors for transient ischemic attack (TIA). However, the clinical implication of OH in the presence of AF is unclear. This study investigates, for the first time, the association between blood pressure (BP), OH and mortality in a cohort of patients with AF and TIA symptoms.
To investigate the incidence of the association between OH, AF and TIA.
This retrospective observational study utilised the Leicester one-stop transient TIA clinic patient database to consider the initial systolic and diastolic BP of 688 patients with a diagnosis of AF. The primary outcome was time until death. Covariant measures included status of AF diagnosis (known or new AF), cardiovascular risk factors, and primary clinic diagnosis [cerebrovascular (CV) versus non-cerebrovascular (non-CV)]. Statistical models adjusted for sex, age, previous AF diagnosis.
Mortality rate was higher in the over 85 age group [191.5 deaths per 1000 person years (py) (95% CI 154.0-238.1)] and lower in the aged 75 and younger age group [40.0 deaths per 1000 py (95% CI 27.0-59.2)] compared to intermediate groups. A 10 mmHg increase in supine diastolic BP was associated with a significant reduction in the hazard of mortality for patients suspected of TIA with AF [adjusted HR 0.79 (95% CI 0.68-0.92), p < 0.001]. The mortality rate for patients with OH was 119.0 deaths per 1000 py compared with a rate of 98.0 for patients without OH (rate ratio 1.2, p = 0.275).
Higher diastolic BP may be a marker for reduced mortality risk in patients with a previous AF diagnosis and non-CV diagnosis. Lower diastolic BP and the presence of AF pertain to a higher mortality risk. This study raises the importance of opportunistic screening for both OH and AF in patients presenting to TIA clinic.
体位性低血压（OH）和心房颤动（AF）均被视为短暂性脑缺血发作（TIA）的独立危险因素。然而，AF存在时OH的临床意义尚不清楚。本研究首次调查了AF和TIA症状患者队列中血压（BP）、OH与死亡率之间的关联。
研究OH、AF与TIA之间关联的发生率。
这项回顾性观察研究利用莱斯特一站式短暂性TIA诊所患者数据库，考量688例诊断为AF患者的初始收缩压和舒张压。主要结局是直至死亡的时间。协变量测量包括AF诊断状态（已知或新发AF）、心血管危险因素和主要诊所诊断[脑血管（CV）与非脑血管（非CV）]。统计模型对性别、年龄、既往AF诊断进行了校正。
与中间年龄组相比，85岁以上年龄组的死亡率更高[每1000人年（py）191.5例死亡（95%CI 154.0 - 238.1）]，75岁及以下年龄组的死亡率更低[每1000 py 40.0例死亡（95%CI 27.0 - 59.2）]。对于疑似AF合并TIA的患者，仰卧位舒张压每升高10 mmHg与死亡风险显著降低相关[校正后风险比（HR）0.79（95%CI 0.68 - 0.92），p < 0.001]。OH患者的死亡率为每1000 py 119.0例死亡，无OH患者的死亡率为每1000 py 98.0例（率比1.2，p = 0.275）。
较高的舒张压可能是既往诊断为AF且非CV诊断患者死亡风险降低的一个标志。较低的舒张压和AF的存在与较高的死亡风险相关。本研究凸显了在TIA诊所就诊患者中对OH和AF进行机会性筛查的重要性。
