Soonil Kwon1, So-Ryoung Lee1, Eue-Keun Choi2,3, Jin-Hyung Jung4, Kyung-Do Han5, Seil Oh1,6, Gregory Y H Lip1,6,7,8. 1. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. 2. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. choiek17@snu.ac.kr. 3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. choiek17@snu.ac.kr. 4. Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 5. Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea. 6. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. 7. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Liverpool, UK. 8. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Abstract
BACKGROUND: The impact of hypertension control on the risk of end-stage renal disease (ESRD) in patients newly diagnosed with atrial fibrillation (AF) is unknown. This study aimed to investigate the impact of hypertension control on incident ESRD among AF patients. METHODS: From the National Health Information database of Korea, we identified ESRD-free patients who were newly diagnosed with AF during 2010 and 2016. The patients were divided into four groups (NN, NH, HN, and HH) according to combinations of dichotomous blood pressure status [normotensive (N) or hypertensive (H)] of two consecutive check-ups. The primary outcome was incident ESRD. Cox proportional hazard regression analysis evaluated ESRD risks across the groups. The association between ESRD risks and changes in blood pressures was also evaluated. RESULTS: During the mean follow-up duration of 3.2 ± 1.9 years, 130,259 ESRD-free patients with AF (mean age 63.1 ± 12.1 years, male 61.2%) were evaluated. Compared to NN, other patient groups showed higher ESRD risks [hazard ratio (95% confidence interval) = 1.43 (1.08-1.89), 1.39 (1.08-1.79), and 2.03 (1.55-2.65) for NH, HN, and HH, respectively]. There was a significant trend of decreasing risks of ESRD in patients with greater reductions in systolic blood pressure after AF diagnosis (p for-trend < 0.001). The association between hypertension control and the ESRD risk was more accentuated in patients with chronic kidney disease. CONCLUSION: Uncontrolled hypertension was associated with an increased risk of incident ESRD in patients with newly diagnosed AF. This study emphasizes the importance of blood pressure control once patients are diagnosed with AF to prevent ESRD.
BACKGROUND: The impact of hypertension control on the risk of end-stage renal disease (ESRD) in patients newly diagnosed with atrial fibrillation (AF) is unknown. This study aimed to investigate the impact of hypertension control on incident ESRD among AF patients. METHODS: From the National Health Information database of Korea, we identified ESRD-free patients who were newly diagnosed with AF during 2010 and 2016. The patients were divided into four groups (NN, NH, HN, and HH) according to combinations of dichotomous blood pressure status [normotensive (N) or hypertensive (H)] of two consecutive check-ups. The primary outcome was incident ESRD. Cox proportional hazard regression analysis evaluated ESRD risks across the groups. The association between ESRD risks and changes in blood pressures was also evaluated. RESULTS: During the mean follow-up duration of 3.2 ± 1.9 years, 130,259 ESRD-free patients with AF (mean age 63.1 ± 12.1 years, male 61.2%) were evaluated. Compared to NN, other patient groups showed higher ESRD risks [hazard ratio (95% confidence interval) = 1.43 (1.08-1.89), 1.39 (1.08-1.79), and 2.03 (1.55-2.65) for NH, HN, and HH, respectively]. There was a significant trend of decreasing risks of ESRD in patients with greater reductions in systolic blood pressure after AF diagnosis (p for-trend < 0.001). The association between hypertension control and the ESRD risk was more accentuated in patients with chronic kidney disease. CONCLUSION: Uncontrolled hypertension was associated with an increased risk of incident ESRD in patients with newly diagnosed AF. This study emphasizes the importance of blood pressure control once patients are diagnosed with AF to prevent ESRD.
Authors: Craig T January; L Samuel Wann; Joseph S Alpert; Hugh Calkins; Joaquin E Cigarroa; Joseph C Cleveland; Jamie B Conti; Patrick T Ellinor; Michael D Ezekowitz; Michael E Field; Katherine T Murray; Ralph L Sacco; William G Stevenson; Patrick J Tchou; Cynthia M Tracy; Clyde W Yancy Journal: Circulation Date: 2014-03-28 Impact factor: 29.690
Authors: Paul K Whelton; Robert M Carey; Wilbert S Aronow; Donald E Casey; Karen J Collins; Cheryl Dennison Himmelfarb; Sondra M DePalma; Samuel Gidding; Kenneth A Jamerson; Daniel W Jones; Eric J MacLaughlin; Paul Muntner; Bruce Ovbiagele; Sidney C Smith; Crystal C Spencer; Randall S Stafford; Sandra J Taler; Randal J Thomas; Kim A Williams; Jeff D Williamson; Jackson T Wright Journal: Hypertension Date: 2017-11-13 Impact factor: 9.897