Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark (L.Y.X., S.Z.D., M.S.O., L.K., J.H.S.).
Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, Denmark (S.Z.D., S.H.).
Hypertension. 2022 Sep;79(9):2081-2090. doi: 10.1161/HYPERTENSIONAHA.122.19333. Epub 2022 Jul 8.
Hypertension is a well-known risk factor for atrial fibrillation (AF) and stoke, but data on the interaction between systolic blood pressure (SBP) and effects of AF screening are lacking.
The LOOP Study randomized AF-naïve individuals aged 70 to 90 years with additional stroke risk factors to either screening with implantable loop recorder (ILR) and anticoagulation initiation upon detection of AF episodes ≥6 minutes, or usual care. In total, 5997 participants with available baseline SBP measurements were included in this substudy. Outcomes were analyzed according to the time-to-first-event principle using cause-specific Cox models.
The hazard ratio of stroke or systemic arterial embolism for ILR versus control decreased with increasing SBP. ILR screening yielded a 44% risk reduction of stroke or systemic arterial embolism among participants with SBP ≥150 mm Hg (adjusted hazard ratio, 0.56 [0.37-0.83]). Within the ILR group, SBP≥150 mm Hg was associated with a higher incidence of AF episodes ≥24 hours than lower SBP (adjusted hazard ratio, 1.70 [1.08-2.69]) but not with the overall occurrence of AF (adjusted >0.05).
The impact of AF screening on thromboembolic events increased with increasing blood pressure. SBP≥150 mm Hg was associated with a >1.5-fold increased risk of AF episodes ≥24 hours, along with an almost 50% risk reduction of stroke or systemic arterial embolism by ILR screening compared to lower blood pressure. These findings should be considered hypothesis-generating and warrant further study.
URL: https://www.
gov; Unique Identifier: NCT02036450.
高血压是心房颤动（AF）和中风的已知危险因素，但缺乏关于收缩压（SBP）与 AF 筛查效果之间相互作用的数据。
LOOP 研究将年龄在 70 至 90 岁之间且具有其他中风危险因素的 AF 初发患者随机分为植入式环路记录仪（ILR）筛查组和常规护理组。对于 ILR 组，在检测到≥6 分钟的 AF 发作时开始抗凝治疗。共纳入 5997 名基线 SBP 可测量的参与者进行了这项亚组研究。采用基于病因的 Cox 模型，根据首次事件时间原则分析结局。
与对照组相比，ILR 筛查组的中风或全身性动脉栓塞的风险比随着 SBP 的升高而降低。在 SBP≥150mmHg 的患者中，ILR 筛查降低中风或全身性动脉栓塞风险 44%（调整后的风险比，0.56[0.37-0.83]）。在 ILR 组中，SBP≥150mmHg 与≥24 小时的 AF 发作发生率高于较低 SBP 相关（调整后的风险比，1.70[1.08-2.69]），但与总体 AF 发生无关（调整后>0.05）。
AF 筛查对血栓栓塞事件的影响随着血压的升高而增加。SBP≥150mmHg 与≥24 小时的 AF 发作风险增加 1.5 倍以上相关，与较低 SBP 相比，ILR 筛查降低中风或全身性动脉栓塞风险近 50%。这些发现应被视为产生假说的依据，并需要进一步研究。
gov；独特标识符：NCT02036450。
