An Epidemiological And Echocardiographic Study On The Association Between Atrial Fibrillation And Hypertension

Objective:Atrial fibrillation and hypertension are prevalent chronic disease conditions in the elderly.In the present study,we investigated the association between blood pressure and atrial fibrillation in an elderly Chinese population.We also investigated the left atrial myocardial deformation in atrial fibrillation patients with and without hypertension using the two-dimensional speckle tracking echocardiographic(2D-STE)strain imaging technique.Method:Our elderly(?65 years)subjects were residents recruited from 6 communities in Shanghai from 2006 to 2018.Atrial fibrillation was systematically screened by resting 12-lead ECG or by a handheld single-lead ECG.Blood pressure status was defined according to the European hypertension guidelines as optimal,normal,or high-normal blood pressure,and stage 1,2 or 3 hypertension.We investigated the relationship between the risk of atrial fibrillation and blood pressure using the logistic and cox proportional hazards regression models,respectively,in cross-sectional and prospective analyses.Furthermore,we investigated left atrial structure and function usingthe 2D STE technique in patients with atrial fibrillation.Result:In a cross-sectional analysis in all participants(n = 6966),the association with atrial fibrillation prevalence was negative for systolic blood pressure(odds ratio [OR] per 10-mm Hg increase 0.79,95% confidence interval [CI] 0.71-0.88,P < 0.0001)but positive for diastolic blood pressure(OR per 5-mm Hg increase 1.11,95% CI 1.02-1.22,P = 0.02).In untreated participants(n = 3544),the association with atrial fibrillation was U-shaped for both systolic and diastolic blood pressure,with the nadir at high-normal blood pressure and a significantly higher prevalence of atrial fibrillation in optimal systolic blood pressure(OR 3.11,95% CI 1.65-5.85,P = 0.004)and stage 2 or 3 diastolic hypertension relative to high-normal blood pressure(OR 8.04,95% CI 2.28-28.3,P = 0.001).In a prospective analysis with a mean 4.7 years follow-up of all participants(n = 5821),the association with atrial fibrillation incidence waspositive for both systolic blood pressure(Hazard ratio [HR] per 10-mm Hg increase 1.14,95% CI 1.04-1.23,P = 0.003)and diastolic blood pressure(HR per 5-mm Hg increase 1.08,95% CI 1.00-1.40,P = 0.03),after adjustment for age and sex.In age-and sex-adjusted Cox regression,we found a significantly higher risk of atrial fibrillation in stage 1(2.08,95% CI 1.07-4.03,P = 0.03)and stage 2 or 3 systolic hypertension(2.54,95% CI 1.26-5.11,P = 0.01)and in stage 1(1.97,95% CI 1.02-3.83,P = 0.04)and stage 2 or 3 systolic and diastolic hypertension(2.61,95% CI 1.31-5.21,P = 0.006)relative to optimal blood pressure.Diastolic hypertension alone tended to be also associated with a higher risk of atrial fibrillation,but statistical significance was not reached(P ? 0.05).The risk of atrial fibrillation in high-normal blood pressure was not significantly different from the optimal blood pressure(P ? 0.05).Left atrial diameter in atrial fibrillation patients with(n = 17)and without hypertension(n = 17)was greater than normotensive elderly people(n = 20)(48.1 ± 8.4 vs.35.7±2.4,P = 0.001;40.9 ± 5.6 vs.35.7 ± 2.4,P = 0.004),and left atrial diameter in atrial fibrillation patients with hypertension greater than those without hypertension(48.1 ± 8.4 vs.40.9 ± 5.6,P = 0.004).In the 2D-STE,atrial fibrillation patients without hypertension showed lower left atrial strain rate during ventricular systole and lower left atrial velocity during early ventricular diastole than normotensive elderly people.Atrial fibrillation patients with hypertension showed lower left atrial velocity,strain,and strain rate during ventricular systole,and early and late ventricular diastole than normotensive elderly people(P < 0.05).Conclusion:In the elderly Chinese people aged 65 years and over,atrial fibrillation prevalence shows a U-shaped relationship with both systolic and diastolic blood pressure,while atrial fibrillation incidence shows a positive liner relationship with blood pressure,and systolic blood pressure was a better predictor than diastolic blood pressure.Atrial fibrillation patients with hypertension have more apparent impaired left atrial deformation mechanics than patients without hypertension.2D-STE can quantitatively detect the impairment of left atrial function among atrial fibrillation patients with and without hypertension.