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(Hypertension. 2008;51:1552.)
© 2008 American Heart Association, Inc.

Original Articles

Atrial Fibrillation and Isolated Systolic Hypertension

The Systolic Hypertension in the Elderly Program and Systolic Hypertension in the Elderly Program-Extension Study

From the Division of Cardiovascular Diseases and Hypertension, University of Medicine and Dentristy of New Jersey (UMDNJ) Robert Wood Johnson Medical School, New Brunswick, NJ.

Correspondence to Tudor D. Vagaonescu, MD, PhD, FACC, Division of Cardiovascular Diseases and Hypertension, UMDNJ Robert Wood Johnson Medical School, One Robert Wood Johnson Place, PO Box 19, MEB 578, New Brunswick, NJ 08903-0019. E-mail vagaonescu{at}medscape.com

We performed a post hoc analysis of the Systolic Hypertension in the Elderly Program database to assess the incidence of atrial fibrillation in the elderly hypertensive population, its influence on cardiovascular events, and whether antihypertensive treatment can prevent its onset. The Systolic Hypertension in the Elderly Program was a double-blind placebo-controlled trial in 4736 subjects with isolated systolic hypertension aged 60 years. Atrial fibrillation was an exclusion criterion from the trial. Participants were randomly assigned to stepped care treatment with chlorthalidone and atenolol (n=2365) or placebo (n=2371). The occurrence of atrial fibrillation and cardiovascular events over 4.7 years as well as the determination of cause of death at 4.7 and 14.3 years were followed. Ninety-eight subjects (2.06%) developed atrial fibrillation over 4.7 years mean follow-up, without significant difference between treated and placebo groups. Atrial fibrillation increased the risk for: total cardiovascular events (RR 1.69; 95% CI 1.21 to 2.36), rapid death (RR 3.29; 95% CI 1.08 to 10.00), total (RR 5.10; 95% CI 3.12 to 8.37) and nonfatal left ventricular failure (RR 5.31; 95% CI 3.09 to 9.13). All-cause and total cardiovascular death were significantly increased in the atrial fibrillation group at 4.7 years (HR 3.44; 95% CI 2.18 to 5.42; HR 2.39; 95% CI 1.05 to 5.43) and 14.3 years follow-up (HR 2.33; 95% CI 1.83 to 2.98; HR 2.21; 95% CI 1.54 to 3.17). Atrial fibrillation increased the risk for total cardiovascular events, rapid death, and left ventricular failure. All-cause mortality and total cardiovascular mortality were significantly increased in hypertensives with atrial fibrillation at 4.7 and 14.3 years follow-up.

Key Words: hypertension • elderly • atrial fibrillation • chlorthalidone • atenolol • incidence • death