From the Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea (S.-R.L., E.-K.C., H.-J.A., S.O.).
Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon (C.S.P.).
Hypertension. 2021 Mar 3;77(3):919-928. doi: 10.1161/HYPERTENSIONAHA.120.16659. Epub 2021 Jan 25.
The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. We aimed to investigate the relationship between hypertension burden and the development of incident AF. Using the Korean National Health Insurance Service database, we identified 3 726 172 subjects who underwent 4 consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22 012 patients (0.59% of the total study population; 1.168 per 1000 person-years). Using the blood pressure (BP) values at each health checkup, we determined the burden of hypertension (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n=742 806), 19% (n=704 623), 19% (n=713 258), 21% (n=766 204), and 21% (n=799 281). Compared with normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semiquantitative analyses with further stratification of stage 1 (systolic BP of 130-139 mm Hg or diastolic BP of 80-89 mm Hg) and stage 2 (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. In this study, both a sustained exposure and the degree of increased BP were associated with an increased risk of incident AF. Tailored BP management should be emphasized to reduce the risk of AF.
高血压负担与心房颤动（AF）发展之间的关系尚不清楚。我们旨在研究高血压负担与新发 AF 之间的关系。我们使用韩国国家健康保险服务数据库，确定了 3726172 名在 2009 年至 2013 年期间接受了 4 次连续年度健康检查且无 AF 病史的患者。在中位随访 5.2 年期间，22012 名患者（占总研究人群的 0.59%；每 1000 人年 1.168 人）新诊断出 AF。根据每次健康检查时的血压（BP）值，我们确定了高血压负担（收缩压≥130mmHg 或舒张压≥80mmHg），根据高血压标准分为 0 至 4 个等级。根据高血压负担量表，将患者分为 1 至 4 组：20%（n=742806）、19%（n=704623）、19%（n=713258）、21%（n=766204）和 21%（n=799281）。与正常人相比，高血压负担为 1、2、3 和 4 的患者发生 AF 的风险分别增加了 8%、18%、26%和 27%。在进行半定量分析并进一步分层 1 期（收缩压 130-139mmHg 或舒张压 80-89mmHg）和 2 期（收缩压≥140mmHg 或舒张压≥90mmHg）高血压后，AF 的风险随着高血压负担的增加而增加，最高可达 71%。在这项研究中，持续暴露和血压升高程度都与新发 AF 的风险增加相关。应强调定制的 BP 管理，以降低 AF 的风险。
