title: Effect of lower on-treatment systolic blood pressure on the risk of atrial fibrillation in hypertensive patients.
abstract: There is a well-established association between hypertension and atrial fibrillation (AF); indeed, even upper normal systolic blood pressures (SBP) are long-term predictors of incident AF. These findings suggest that more aggressive BP control may reduce the risk of new AF. However, whether lower achieved SBP is associated with a lower incidence of AF remains unclear. The risk of new-onset AF was examined in relation to last in-treatment SBP before AF diagnosis or last in-study measurement in the absence of new AF in 8831 hypertensive patients with ECG left ventricular hypertrophy with no history of AF, in sinus rhythm on their baseline ECG, randomly assigned to losartan- or atenolol-based treatment. Patients with in-treatment SBP ≤130 mm Hg (lowest quintile at last measurement) and SBP between 131 and 141 mm Hg were compared with patients with in-treatment SBP ≥142 mm Hg (median SBP at last measurement). During follow-up of 4.6±1.1 years, new-onset AF was diagnosed in 701 patients (7.9%). In multivariate Cox analyses, compared with in-treatment SBP ≥142 mm Hg, in-treatment SBP ≤130 mm Hg entered as a time-varying covariate was associated with a 40% lower risk (95% confidence interval, 18%-55%) and in-treatment SBP of 131 to 141 mm Hg with a 24% lower risk (95% confidence interval, 7%-38%) of new AF. Thus, achieved SBP ≤130 mm Hg is associated with a lower risk of new-onset AF in hypertensive patients with ECG left ventricular hypertrophy. Further study is needed to determine whether targeting hypertensive patients without AF to lower SBP goals can reduce the burden of new AF in this high-risk population.
  
  
  BACKGROUND
  URL: http://clinicaltrials.gov. Unique identifier: NCT00338260.
authors.affiliation: From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W.); and Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.). pokin@med.cornell.edu.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.affiliation: From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W.); and Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.).
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Hille
authors.affiliation: From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W.); and Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.).
authors.forename: Anne Cecilie K
authors.initials: AC
authors.lastname: Larstorp
authors.affiliation: From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W.); and Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.).
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.affiliation: From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W.); and Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.).
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.affiliation: From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W.); and Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.).
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.affiliation: From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W.); and Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.).
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001262:Atenolol / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000503:physiopathology; D015994:Incidence; D019808:Losartan / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D013599:Systole / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001262:Atenolol; D019808:Losartan
keywords: atrial fibrillation; blood pressure; electrocardiography; hypertension; hypertrophy