Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul.
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
J Hypertens. 2022 Jan 1;40(1):128-135. doi: 10.1097/HJH.0000000000002987.
The excess risk of atrial fibrillation in relation to the presence of proteinuria associated with hypertension has not been well elucidated. We aimed to determine the effect of hypertension and/or proteinuria on the incidence of atrial fibrillation. Second, we evaluated whether the associations with temporal changes in proteinuria status on the incidence of atrial fibrillation.
A total of 85 434 participants with hypertension and 125 912 participants without hypertension with age at least 60 years from the Korea National Health Insurance Service-Senior cohort were included. Amongst controls (participants without proteinuria and hypertension), hypertension only, proteinuria only, and hypertension with proteinuria groups, the adjusted incidences of atrial fibrillation were 0.51, 0.69. 0.78 and 0.99 per 100 person-years, respectively after inverse probability of treatment weighting. Compared with controls, the weighted risks of atrial fibrillation in the hypertension only, proteinuria only and hypertension with proteinuria groups were increased by 37% (hazard ratio 1.37, 95% confidence interval, CI 1.30-1.44, P = 0.001), 55% (hazard ratio 1.55, 95% CI 1.28-1.88, P < 0.001), and 98% (hazard ratio 1.98, 95% CI 1.62-2.43, P < 0.001), respectively. Populations who had proteinuria in the first examination had an increased risk of atrial fibrillation even in the group whereby the proteinuria was resolved on the second examination (hazard ratio 1.36, 95% CI 1.12-2.31, P < 0.001). The presence of proteinuria in first and second analysis had the highest risk of incident atrial fibrillation (hazard ratio 1.61, 95% CI 1.12-2.31).
In conclusion, hypertension and/or proteinuria were associated with increased risk of atrial fibrillation, with the greatest risks when both are present. Proteinuria could be a useful factor for predicting atrial fibrillation development.
与高血压相关的蛋白尿引起的房颤风险增加尚未得到充分阐明。我们旨在确定高血压和/或蛋白尿对房颤发生率的影响。其次，我们评估了蛋白尿状态随时间变化与房颤发生的相关性。
共纳入了 85434 名患有高血压和 125912 名无高血压的年龄至少 60 岁的韩国国家健康保险服务-老年人队列参与者。在对照组（无蛋白尿和高血压的参与者）中，高血压组、蛋白尿组、高血压合并蛋白尿组的房颤发生率分别为 0.51、0.69、0.78 和 0.99/100 人年，经逆概率治疗加权后。与对照组相比，高血压组、蛋白尿组和高血压合并蛋白尿组的房颤加权风险分别增加了 37%（风险比 1.37，95%置信区间 1.30-1.44，P=0.001）、55%（风险比 1.55，95%置信区间 1.28-1.88，P<0.001）和 98%（风险比 1.98，95%置信区间 1.62-2.43，P<0.001）。首次检查时存在蛋白尿的人群，即使在第二次检查时蛋白尿已缓解的人群中，也存在房颤风险增加（风险比 1.36，95%置信区间 1.12-2.31，P<0.001）。首次和第二次分析中存在蛋白尿的人群发生房颤的风险最高（风险比 1.61，95%置信区间 1.12-2.31）。
总之，高血压和/或蛋白尿与房颤风险增加相关，两者同时存在时风险最大。蛋白尿可能是预测房颤发生的有用因素。
