Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom.
J Hum Hypertens. 2021 Aug;35(8):667-677. doi: 10.1038/s41371-020-0383-8. Epub 2020 Jul 21.
Atrial fibrillation (AF) and hypertension often co-exist and both are associated with endothelial dysfunction. We hypothesised that AF would further worsen endothelium-dependent flow-mediated dilatation (FMD) in hypertension patients compared to those without AF. In a cross-sectional comparison, we measured brachial artery diameter at rest and during reactive hyperaemia following 5 min of arterial occlusion in two patient groups: AF (and hypertension) (n = 61) and hypertension control groups (n = 33). The AF (and hypertension) subgroups: permanent AF (n = 30) and paroxysmal AF (n = 31) were also assessed. The permanent AF patients received heart rate and blood pressure (BP) control optimisation and were then followed up after eight weeks for repeat FMD testing. There was no significant difference in FMD between AF (and hypertension) group and hypertension control group (4.6%, 95% CI [2.6-5.9%] vs 2.6%, 95% CI [1.9-5.3%]; p = 0.25). There was a significant difference in FMD between permanent AF and paroxysmal AF groups (3.1%, 95% CI [2.3-4.8%] vs 5.9%, 95% CI [4.0-8.1%]; p = 0.02). Endothelium-dependent FMD response showed a non-significant improvement trend following eight weeks of heart rate and BP optimisation (3.1%, 95% CI [2.3-4.8%] (baseline) vs 5.2%, 95% CI [3.9-6.5%] (follow up), p = 0.09). Presence of AF generally does not incrementally worsen endothelial dysfunction in hypertension patients, although the duration and frequency of AF (paroxysmal AF to permanent AF) does lead to worsening endothelial function. Eight weeks of BP optimisation did not significantly improve endothelial dysfunction as measured by FMD.
心房颤动（AF）和高血压常并存，两者均与内皮功能障碍有关。我们假设与无 AF 的高血压患者相比，AF 会进一步加重高血压患者的内皮依赖性血流介导的舒张功能（FMD）。在一项横断面比较中，我们测量了两组患者的肱动脉直径：AF（和高血压）组（n=61）和高血压对照组（n=33）。在动脉闭塞 5 分钟后，通过反应性充血来测量肱动脉直径，记录其在休息时和充血时的直径。还评估了 AF（和高血压）亚组：永久性 AF（n=30）和阵发性 AF（n=31）。永久性 AF 患者接受心率和血压（BP）控制优化，然后在八周后进行重复 FMD 测试。AF（和高血压）组和高血压对照组之间的 FMD 无显著差异（4.6%，95%CI[2.6-5.9%]与 2.6%，95%CI[1.9-5.3%]；p=0.25）。永久性 AF 与阵发性 AF 组之间的 FMD 有显著差异（3.1%，95%CI[2.3-4.8%]与 5.9%，95%CI[4.0-8.1%]；p=0.02）。在进行了八周的心率和 BP 优化后，FMD 呈现出非显著的改善趋势（3.1%，95%CI[2.3-4.8%]（基线）与 5.2%，95%CI[3.9-6.5%]（随访），p=0.09）。一般来说，AF 的存在不会使高血压患者的内皮功能障碍进一步恶化，尽管 AF 的持续时间和频率（阵发性 AF 至永久性 AF）确实会导致内皮功能障碍恶化。八周的 BP 优化并不能显著改善 FMD 测量的内皮功能障碍。
