Cross-sectional Association Between Blood Pressure Status and Atrial Fibrillation in an Elderly Chinese Population

Abstract

OBJECTIVE Atrial fibrillation (AF) and hypertension are prevalent chronic disease conditions in the elderly population. In the present cross-sectional study, we investigated the association between blood pressure (BP) and AF in an elderly Chinese population. METHOD Our elderly (≥65 years) subjects were residents recruited from 6 communities in Shanghai from 2006 to 2017. Atrial fibrillation was systematically screened by rest 12-lead electrocardiogram (ECG) or by a handheld single-lead ECG. BP status was defined according to the European hypertension guidelines as optimal, normal, or high-normal BP, and stage 1, 2, or 3 hypertension. RESULT In the 6,966 participants (women 56.0%, mean age: 72.3 years), the prevalence of AF was 3.3%, and the prevalence of hypertension was 58.7% (83.7% treated). In all participants, the association with prevalent AF was negative for systolic BP (odds ratio [OR] per 10-mm Hg increase 0.79, 95% confidence interval [CI]: 0.71–0.88, P < 0.0001) but positive for diastolic BP (OR per 5-mm Hg increase 1.11, 95% CI: 1.02–1.22, P = 0.02). In untreated participants (n = 3,544), the association with prevalent AF was U-shaped for both systolic and diastolic BP, with the nadir at high-normal BP and a significantly higher risk of prevalent AF in optimal systolic BP (OR: 3.11, 95% CI: 1.65–5.85, P = 0.004) and stage 2 or 3 diastolic hypertension relative to the nadir (OR: 8.04, 95% CI: 2.28–28.3, P = 0.001). CONCLUSION In the elderly population, BP shows a complicated relationship with prevalent AF, with high-normal BP at the lowest risk and optimal systolic BP and stage 2 or 3 diastolic hypertension at increased risks.

Explainable Machine Learning for Atrial Fibrillation in the General Population Using a Generalized Additive Model ― A Cross-Sectional Study ―

“…A cross-sectional study enrolling elderly subjects suggested a negative relationship between SBP and AF prevalence. 29 A similar trend has been observed in other studies that enrolled and followed older subjects who started hemodialysis. 30 In subjects receiving antihypertensive treatment, a J-shaped relationship between SBP and AF was observed.…”

Epidemiology of atrial fibrillation in northeast China: a cross-sectional study, 2017–2019

“…A considerable cardiovascular burden in northeast China was recently confirmed 9. However, previous studies on AF epidemiology were limited by relatively small sample size,10 non-representative sampling,4 restricted region and population8 or insufficient estimation of AF characteristics 11. Therefore, accurate and comprehensive estimation of the disease burden of AF in northeast China is still lacking.…”

Association of systolic blood pressure with atrial fibrillation among treated hypertensive patients

“…Low SBP may indeed increase the risk of AF via chronic coronary ischemia, myocardial proliferation and fibrosis induced by inadequate coronary perfusion which leads to the development of AF. On the other hand, low SBP may be the result of AF or AF-related cardiac structural and functional abnormalities (10,28). Another explanation may be that individuals with higher SBP levels are more likely to receive better clinical care and more usage of antihypertensive medications, which plays an important role in the mutually influenced relationship between hypertension and AF.…”

“…However, there is limited and conflicting data on the association between AF and the degree of systolic blood pressure (SBP) control in hypertensive patients, especially in patients receiving antihypertensive treatment. Studies were even fewer in Chinese regions (10,11). In the present study, we investigated the relationship between SBP and AF in a group of hypertensive patients in Chinese population with or without antihypertensive medications.…”