title: Racial differences in incident atrial fibrillation among hypertensive patients during antihypertensive therapy.
abstract: BACKGROUND
  Blacks have a higher prevalence of risk factors for atrial fibrillation (AF), such as hypertension, obesity, and heart failure, than nonblacks. Although population-based studies have demonstrated a lower prevalence and incidence of AF in blacks, the relationship of incident AF to race among hypertensive patients undergoing blood pressure lowering has been less extensively examined.
  
  
  METHODS
  Incident AF was examined in 518 black and 8,313 nonblack hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) with no history of AF in sinus rhythm on their baseline electrocardiogram, who were randomly assigned to losartan- or atenolol-based treatment.
  
  
  RESULTS
  During a mean of 4.7±1.1 years of follow-up, new-onset AF occurred in 701 patients (7.9%); 5-year AF incidence was significantly lower in black than nonblack patients (6.1 vs. 8.3%; P = 0.03). In univariable Cox analyses, black race was associated with a 37% lower risk of new AF (hazard ratio (HR) = 0.63; 95% confidence interval (CI) = 0.45-1.00; P = 0.05). In multivariable Cox analyses adjusting for randomized treatment, age, sex, diabetes, history of heart failure, myocardial infarction, ischemic heart disease, stroke, peripheral vascular disease, smoking status, baseline body mass index, serum total and high-density lipoprotein cholesterol, creatinine, glucose, and urine albumin/creatinine ratio as standard risk factors, and for incident myocardial infarction, in-treatment heart rate, systolic and diastolic pressure, Cornell product, and Sokolow-Lyon voltage LVH treated as time-varying covariables, black race remained associated with a 45% decreased risk of developing new AF (HR = 0.55; 95% CI = 0.35-0.87; P = 0.01).
  
  
  CONCLUSIONS
  Incident AF is substantially less common among black than nonblack hypertensive patients.
authors.affiliation: Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York; pokin@med.cornell.edu.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.affiliation: Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York;
authors.forename: Casper N
authors.initials: CN
authors.lastname: Bang
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark;
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.affiliation: Merck Research Labs, West Point, Pennsylvania;
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Hille
authors.affiliation: Department of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan;
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan;
authors.forename: Stevo
authors.initials: S
authors.lastname: Julius
authors.affiliation: Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.affiliation: Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York;
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D044383:Black People; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology; D015994:Incidence; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D044465:White People
chemical_list: D000959:Antihypertensive Agents; D019808:Losartan
keywords: blood pressure; electrocardiography; fibrillation; hypertension; hypertrophy.