Arterial Stiffness Predicts Incident Atrial Fibrillation in the Framingham Heart Study
A Mechanistic Contribution in People With High Blood Pressure or History of Hypertension
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See related article, pp 590–596
Hypertension is, due to the high prevalence in the general population, by far the most important risk factor for the development of atrial fibrillation (AF). A recent study confirmed that blood pressures even in the upper normal or prehypertensive range are associated with an increased risk of AF.1 Independently, in people with high cardiovascular risk,2 left ventricular hypertrophy, serum creatinine, history of hypertension, and history of cerebrovascular disease were highly significant predictors, as were body mass index and history of coronary heart disease. This analysis2 of populations participating in 2 large outcome trials of similar design (n=30 424) documented the connection between hypertension, or its end-organ damage as well as risk factors, and the risk of incident AF. The relationship between the history of hypertension and risk of AF persists, despite confounding by the extensive vascular disease or complicated diabetes mellitus that the participants had,2 or maybe these diseases even escalated the relationship.
The dominating role of high blood pressure in the pathogenesis, pathophysiology, prediction, diagnosis, and treatment of AF has been extensively reviewed by a working group of the European Society of Hypertension.3 Perhaps the most remarkable finding was that up to ≈90% of patients with AF who participated in some of the recent large randomized clinical outcome trials of new anticoagulant or antiarrhythmic medications in people with AF had a history of hypertension3 even without baseline workup using ambulatory 24-hour blood pressure measurements to detect people with masked hypertension. This suggests that AF is in most cases a typical complication of hypertension, and even more so than stroke or heart failure.
It is not entirely surprising but confirmatory in a slightly different type of population that left ventricular hypertrophy is a strong predictor of AF. In a large …