Maria-Angela Losi1, Raffaele Izzo2, Marina De Marco2, Grazia Canciello1, Antonio Rapacciuolo1, Valentina Trimarco3, Eugenio Stabile1, Francesco Rozza2, Giovanni Esposito1, Nicola De Luca2, Giovanni de Simone4, Bruno Trimarco1. 1. Hypertension Research Center, Federico II University, Naples, Italy; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. 2. Hypertension Research Center, Federico II University, Naples, Italy; Department of Translational Medical Sciences, Federico II University, Naples, Italy. 3. Hypertension Research Center, Federico II University, Naples, Italy; Department of Neurosciences, Federico II University, Naples, Italy. 4. Hypertension Research Center, Federico II University, Naples, Italy; Department of Translational Medical Sciences, Federico II University, Naples, Italy. Electronic address: simogi@unina.it.
Abstract
BACKGROUND: Interaction of cardiovascular (CV) risk factors with structural and hemodynamic alterations as combined promoters of atrial fibrillation (AF) is not yet well studied. We designed an observational, longitudinal, retrospective study to predict risk of incident AF by combination of CV risk profile, target organ damage and therapy in hypertensive patients. METHODS AND RESULTS: We studied 7062 hypertensive patients without history of AF or prevalent CV disease, with ejection fraction (EF) of ≥50%, and no more than stage III chronic kidney disease. The patients were selected from an open registry, the Campania-Salute Network, collecting information from general practitioners and community hospitals, in the Campania Region, Southern Italy, networked with the Hypertension Center of Federico II University Hospital in Naples. The end-point of the present analysis was the detection of first episode of AF by ECG or hospital admission, at any point throughout follow-up (median 36months [IQR=10-74]). During follow-up, AF developed in 117 patients. Baseline older age, greater left atrial diameter (LAd), left ventricular mass (LVM), and intimal medial thickness (IMT) were independent predictors of AF (all p<0.0001), with no effect of CV risk factors. Beta-blockers and diuretics increased risk of incident AF; use of medications inhibiting renin-angiotensin system (RAS) reduced risk by 50% (all p<0.002). CONCLUSIONS: Older age, increased LAd, and markers of target organ damage (increased LVM and IMT), identify the hypertensive phenotype at highest risk for AF. CV risk factors do not exhibit significant, independent association. Patients on anti-RAS therapy are exposed to lower risk of incident AF.
BACKGROUND: Interaction of cardiovascular (CV) risk factors with structural and hemodynamic alterations as combined promoters of atrial fibrillation (AF) is not yet well studied. We designed an observational, longitudinal, retrospective study to predict risk of incident AF by combination of CV risk profile, target organ damage and therapy in hypertensivepatients. METHODS AND RESULTS: We studied 7062 hypertensivepatients without history of AF or prevalent CV disease, with ejection fraction (EF) of ≥50%, and no more than stage III chronic kidney disease. The patients were selected from an open registry, the Campania-Salute Network, collecting information from general practitioners and community hospitals, in the Campania Region, Southern Italy, networked with the Hypertension Center of Federico II University Hospital in Naples. The end-point of the present analysis was the detection of first episode of AF by ECG or hospital admission, at any point throughout follow-up (median 36months [IQR=10-74]). During follow-up, AF developed in 117 patients. Baseline older age, greater left atrial diameter (LAd), left ventricular mass (LVM), and intimal medial thickness (IMT) were independent predictors of AF (all p<0.0001), with no effect of CV risk factors. Beta-blockers and diuretics increased risk of incident AF; use of medications inhibiting renin-angiotensin system (RAS) reduced risk by 50% (all p<0.002). CONCLUSIONS: Older age, increased LAd, and markers of target organ damage (increased LVM and IMT), identify the hypertensive phenotype at highest risk for AF. CV risk factors do not exhibit significant, independent association. Patients on anti-RAS therapy are exposed to lower risk of incident AF.
Authors: Cengiz Burak; Metin Çağdaş; Ibrahim Rencüzoğulları; Yavuz Karabağ; Inanç Artaç; Mahmut Yesin; Tufan Çınar; Ibrahim Yıldız; Muhammed Suleymanoglu; Halil Ibrahim Tanboğa Journal: J Clin Hypertens (Greenwich) Date: 2019-04-05 Impact factor: 3.738
Authors: Mai Tone Lønnebakken; Raffaele Izzo; Costantino Mancusi; Eva Gerdts; Maria Angela Losi; Grazia Canciello; Giuseppe Giugliano; Nicola De Luca; Bruno Trimarco; Giovanni de Simone Journal: J Am Heart Assoc Date: 2017-03-08 Impact factor: 5.501