The Prevalence And The Risk Factors Of Atrial Fibrillation In In-hospital Hypertensive Patients

Objective: To evaluate the prevalence of atrial fibrillation(AF)in hypertensive patients,and to identifythe risk factors associated with AF.Method: A total of 831 hospitalized patients in the department of Cardiology from January 1,2015 to June 1,2016 at the Second Affiliated Hospital of Dalian Medical University were collected.Based on the ACC/AHA/ESC criteria,these patients were classified into two groups: NAF group(patients without AF)and AF group.A total of366 males and 465 females were ultimately enrolled in this study and the mean age was 65.7 ± 11.5 years.Clinical characteristics,laboratory data were compared between two groups.The risk factors for AF were analyzed by logistic regression.We performed the correlation between the use of Angiotensin-Converting Enzyme Inhibitors/angiotensin receptor inhibitor(ACEI/ARB)and ?-blockers and the echocardiographic data,then the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of these risk factors.Results: 1.Of the 831 patients,272(32.7%)fulfilled the criteria for AF,83(10.0%)had new-onset AF,131(15.7%)had paroxysmal AF and 58(7.0%)had persistent AF.2.Compared with the NAF group patients,patients with AF were older and had higher level of systolic pressure,pulse pressure,mean platelet volume,platelet distribution width,serum uric acid,serum creatinine and lower level of platelet,serum albumin,serum total cholesterol,low density lipoprotein cholesterol.AF was more frequent in those without the use of ACEI/ARB or ?-blockers before admission.Moreover,patients with AF had a higher level of left atrial diameter,left ventricular end diastolic diameter,interventricular septal thickness and left ventricular posterior wall.However,no difference was found between the two groups with the level of body mass index,hemoglobin,diastolic pressure,serum triglyceride and the use of calcium channel blockers.3.On logistic regression,age(OR=1.054,95%CI 1.033-1.076,P<0.001),an elevated pulse pressure(OR=2.518,95%CI 1.728-3.668,P<0.001),left atrial diameter(OR=1.202,95%CI 1.153-1.252,P<0.001),mean platelet volume(OR=1.115,95%CI 1.005-1.238,P=0.040)were the independent risk factors for AF,while serum total cholesterol(OR=0.727,95%CI 0.589-0.896,P=0.003),the treatment with ACEI/ARB(OR=0.505,95%CI 0.327-0.781,P=0.002)and or with?-blockers before admission(OR=0.466,95%CI 0.305-0.712,P<0.001)were the protective factors for AF.4.We divided left atrial diameter,age,pulse pressure,serum total cholesterol and mean platelet volume into quarters,The highest quartile of left atrial diameter,age,pulse pressure,serum total cholesterol and mean platelet volume were associated with10.1-fold?3.7-fold?3.6-fold?0.5-fold?1.8-fold,respectively,increased risk of incident AF compared with the lowest quartile.5.Age,left atrial diameter,pulse pressure,serum total cholesterol,mean platelet volume had certain predictive value for AF in patients with hypertension and the cut-off were 62.5 years old,39.5mm,65.5mm Hg,4.3mmol/L,10.6f L,respectively.Moreover,for predicting the prevalence of AF,left atrial diameter displayed an excellent areas under the ROC curve(AUROC=0.764±0.019,P<0.001)6.There were significant negative correlations between ACEI/ARB and interventricular septal thickness(r=-0.117,P<0.01)and left ventricular posterior wall(r=-0.112,P<0.01).What's more,?-blockers were negatively correlated with left atrial diameter(r=-0.079,P<0.05),left ventricular end diastolic diameter(r=-0.071,P<0.05).Conclusion:1.The prevalence of AF is high in hypertensive patients.2.The independent risk factor for AF were age,left atrial diameter,mean platelet volume and the elevated pulse pressure,while the level of serum total cholesterol and the treatment with angiotensin converting enzyme inhibitors/angiotensin II receptor antagonists or ?-blockers were protective factors.