Department of Internal Medicine, Korea University College of Medicine, Seoul (K.J.K.).
Department of Internal Medicine (N.H., H.L., S.L., Y.R.), Yonsei University College of Medicine, Seoul.
Hypertension. 2021 Jun;77(6):1964-1973. doi: 10.1161/HYPERTENSIONAHA.120.16909. Epub 2021 Apr 19.
[Figure: see text]. Increased risk of atrial fibrillation was reported in patients with primary aldosteronism. However, data are limited regarding the time-dependent risk of atrial fibrillation in surgically or medically treated primary aldosteronism. From the National Health Insurance Claim database in Korea (2003–2017), a total of 1418 patients with primary aldosteronism (adrenalectomy [ADX], n=755, mineralocorticoid receptor antagonist n=663) were age- and sex-matched at a 1:5 ratios to patients with essential hypertension (n=7090). Crude incidence of new onset atrial fibrillation was 2.96% in primary aldosteronism and 1.97% in essential hypertension. Because of nonproportional hazard observed in new onset atrial fibrillation, analysis time was split at 3 years. Compared with essential hypertension, risk of new onset atrial fibrillation peaked at 1 year gradually declined but remained elevated up to 3 years in overall treated primary aldosteronism (adjusted hazard ratio [aHR] 3.02; P<0.001) as well as in both ADX (aHR, 3.54; P<0.001) and mineralocorticoid receptor antagonist groups (aHR 2.27; P=0.031), which became comparable to essential hypertension afterward in both groups (ADX aHR, 0.38; P=0.102; mineralocorticoid receptor antagonist aHR, 0.60; P=0.214). Nonetheless, mineralocorticoid receptor antagonist group was associated with increased risk of nonfatal stroke (aHR, 1.21; P=0.031) compared with essential hypertension, whereas ADX was not (aHR, 1.26; P=0.288). Our results suggest the risk of new-onset atrial fibrillation remained elevated up to 3 years in treated primary aldosteronism compared with essential hypertension, which declined to comparable risk in essential hypertension thereafter. Monitoring for atrial fibrillation up to 3 years after treatment, particularly ADX, might be warranted.
[图：见正文]。原发性醛固酮增多症患者的心房颤动风险增加。然而，关于手术或药物治疗原发性醛固酮增多症的心房颤动的时间依赖性风险的数据有限。从韩国国民健康保险索赔数据库（2003-2017 年）中，按年龄和性别以 1:5 的比例匹配了 1418 名原发性醛固酮增多症患者（肾上腺切除术 [ADX]，n=755，盐皮质激素受体拮抗剂 n=663）与原发性高血压患者（n=7090）。原发性醛固酮增多症的新发心房颤动粗发生率为 2.96%，原发性高血压为 1.97%。由于新发心房颤动的比例不相等，因此将分析时间分为 3 年。与原发性高血压相比，总体治疗后的原发性醛固酮增多症（校正后的危险比[aHR]3.02；P<0.001）以及 ADX（aHR，3.54；P<0.001）和盐皮质激素受体拮抗剂组（aHR 2.27；P=0.031）的新发心房颤动风险在 1 年内达到峰值，然后逐渐下降，但在 3 年内仍处于升高状态，此后与原发性高血压相比，两组的风险变得相似（ADX aHR，0.38；P=0.102；盐皮质激素受体拮抗剂 aHR，0.60；P=0.214）。尽管如此，与原发性高血压相比，盐皮质激素受体拮抗剂组发生非致命性卒中的风险增加（aHR，1.21；P=0.031），而 ADX 则没有（aHR，1.26；P=0.288）。我们的研究结果表明，与原发性高血压相比，治疗后的原发性醛固酮增多症患者新发心房颤动的风险在 3 年内仍处于升高状态，此后风险降至与原发性高血压相当。此后，可能需要在治疗后 3 年内监测心房颤动，尤其是 ADX。
