From the Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel.
Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel.
Hypertens Res. 2022 Sep;45(9):1496-1504. doi: 10.1038/s41440-022-00920-5. Epub 2022 Apr 20.
Hypertension is a well-established risk factor for the onset and progression of atrial fibrillation (AF). Blood pressure (BP) measurements during routine exercise stress testing (EST) may identify subjects at increased risk for developing AF. We performed a retrospective analysis of treadmill EST carried out using the Bruce protocol in patients aged ≥40 years without a history of AF (n = 17,617; 42% women). BP was measured at rest, peak exercise, and 2-min recovery and analyzed for its association with the risk for developing AF. During a mean follow-up of 7 years, AF was documented in 4.5% of the patients. The incidence rate of AF per 1000 person-years increased with the rise in CHADSVASc scores (3.26 for a Score=0 to 19.78 for scores ≥6). In a multivariate analysis, adjusting for risk score components and exercise capacity, systolic BP measurements taken at rest (≥130 vs. ≤110 mmHg), peak exercise (>170 vs. ≤150 mmHg), and recovery (>150 vs. ≤130 mmHg) were associated with an increased risk for AF: the hazard ratios (HRs) were 1.56 (95% CI, 1.30-1.87), 1.21 (1.01-1.45), and 1.33 (1.10-1.62), respectively. Similarly, diastolic BP measurements taken at rest (≥90 vs. <80 mmHg), peak exercise (≥100 vs. <90 mmHg), and recovery (>90 vs. ≤80 mmHg) were associated with an increased risk for AF: the HRs were 1.80 (1.36-2.38), 2.08 (1.28-3.37), and 1.56 (0.81-3.02), respectively. The association of exercise BP with AF was further observed when the BPs were analyzed as continuous variables and in subjects without a baseline diagnosis of hypertension. In conclusion, systolic and diastolic BP taken at the rest, peak exercise and recovery phases of EST may provide independent predictive information regarding future risk for developing AF.
高血压是心房颤动（AF）发病和进展的一个明确的危险因素。在常规运动应激测试（EST）期间测量血压（BP）可能会发现发生 AF 风险增加的患者。我们对使用 Bruce 方案进行的年龄≥40 岁且无 AF 病史的患者（n=17617；42%为女性）进行了回溯性分析。在休息时、运动峰值时和 2 分钟恢复期测量 BP，并分析其与发生 AF 的风险的关系。在平均 7 年的随访期间，4.5%的患者发生了 AF。每 1000 人年的 AF 发生率随着 CHADSVASc 评分的升高而增加（评分 0 时为 3.26，评分≥6 时为 19.78）。在多变量分析中，调整风险评分成分和运动能力后，休息时的收缩压测量值（≥130 与≤110mmHg）、运动峰值时的收缩压测量值（>170 与≤150mmHg）和恢复期的收缩压测量值（>150 与≤130mmHg）与 AF 风险增加相关：风险比（HRs）分别为 1.56（95%CI，1.30-1.87）、1.21（1.01-1.45）和 1.33（1.10-1.62）。同样，休息时的舒张压测量值（≥90 与<80mmHg）、运动峰值时的舒张压测量值（≥100 与<90mmHg）和恢复期的舒张压测量值（>90 与≤80mmHg）与 AF 风险增加相关：HRs 分别为 1.80（1.36-2.38）、2.08（1.28-3.37）和 1.56（0.81-3.02）。当以连续变量分析 BPs 并在基线无高血压诊断的患者中进行分析时，仍观察到 EST 休息、运动峰值和恢复期的 BP 与 AF 之间的关联。总之，EST 休息时、运动峰值时和恢复期时的收缩压和舒张压测量值可能提供关于未来发生 AF 的风险的独立预测信息。
