Effect of Intensive Blood Pressure Lowering on the Risk of Atrial Fibrillation

Amuzescu

2021

Sci Rep

Myocardium transcriptomes of left and right atria and ventricles from four adult male C57Bl/6j mice were profiled with Agilent microarrays to identify the differences responsible for the distinct functional roles of the four heart chambers. Female mice were not investigated owing to their transcriptome dependence on the estrous cycle phase. Out of the quantified 16,886 unigenes, 15.76% on the left side and 16.5% on the right side exhibited differential expression between the atrium and the ventricle, while 5.8% of genes were differently expressed between the two atria and only 1.2% between the two ventricles. The study revealed also chamber differences in gene expression control and coordination. We analyzed ion channels and transporters, and genes within the cardiac muscle contraction, oxidative phosphorylation, glycolysis/gluconeogenesis, calcium and adrenergic signaling pathways. Interestingly, while expression of Ank2 oscillates in phase with all 27 quantified binding partners in the left ventricle, the percentage of in-phase oscillating partners of Ank2 is 15% and 37% in the left and right atria and 74% in the right ventricle. The analysis indicated high interventricular synchrony of the ion channels expressions and the substantially lower synchrony between the two atria and between the atrium and the ventricle from the same side.

Section: Discussionsupporting

confidence: 70%

Transcriptomic uniqueness and commonality of the ion channels and transporters in the four heart chambers

Amuzescu

2021

Sci Rep

“…Hypertension is the most common and important modifiable AF risk factor [2,3,22,23]. In a SPRINT sub-analysis, intensive BP control targeting SBP < 120 mm Hg was related with a lower risk of new-onset AF [13]. In contrast, the present study found a U-shaped relationship was observed between BP and incident AF in both non-octogenarians and octogenarians.…”

Section: Discussioncontrasting

confidence: 79%

“…The present study recruited participants aged over 60 years, with the median age of our population being 71.7 years, much older than previous studies [11][12][13], and 6.8% of overall population were individuals of age over 80 years. The elderly population had more comorbidities, and these factors may influence the U-shaped relationship.…”

Section: Discussionmentioning

confidence: 90%

“…Other report have shown that the intensive therapy group (target SBP < 120 mm Hg) did not show statistical significance with respect to the incidence of AF in patients with hypertension and diabetes [12]. A recent study, using data from Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive treatment with a target SBP of <120 mm Hg in patients with hypertension at high risk of cardiovascular disease reduced the risk of AF [13]. However, the relationship of BP and incident AF has not been established in older subjects.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

What Is the Ideal Blood Pressure Threshold for the Prevention of Atrial Fibrillation in Elderly General Population?

Park

Yang

et al. 2020

JCM

Intensive blood pressure (BP) lowering in patients with hypertension at increased risk of cardiovascular disease has been associated with a lowered risk of incident atrial fibrillation (AF). It is uncertain whether maintaining the optimal BP levels can prevent AF in the general elderly population. We included 115,866 participants without AF in the Korea National Health Insurance Service-Senior (≥60 years) cohort from 2002 to 2013. We compared the influence of BP on the occurrence of new-onset AF between octogenarians (≥80 years) and non-octogenarians (<80 years) subjects. With up to 6.7 ± 1.7 years of follow-up, 4393 incident AF cases occurred. After multivariable adjustment for potentially confounding clinical covariates, the risk of AF in non-octogenarians was significantly higher in subjects with BP levels of <120/<80 and ≥140/90 mm Hg, with hazard ratios of 1.15 (95% confidence interval (CI), 1.03–1.28; p < 0.001) and 1.14 (95% CI, 1.04–1.26; p < 0.001), compared to the optimal BP levels (120–129/<80 mm Hg). In octogenarians, the optimal BP range was 130–139/80–89 mm Hg, higher than in non-octogenarians. A U-shaped relationship for the development of incident AF was evident in non-octogenarians, and BP levels of 120–129/<80 mm Hg were associated the lowest risk of incident AF. Compared to non-octogenarians, the lowest risk of AF was associated with higher BP levels of 130–139/80–89 mm Hg amongst octogenarians.

“… 9 – 11 Comparisons of intensive blood pressure lowering with standard blood pressure lowering have suggested a benefit for patients with hypertension and elevated risk of cardiovascular events but not hypertension and diabetes. 12 , 13 The inconsistent findings of antihypertensive therapy studies and observational studies have led some to question the strength of the direct relationship between blood pressure and AF or argue that it is driven by isolated subpopulations. 14 – 17 …”

mentioning

confidence: 99%

Genetically Predicted Blood Pressure and Risk of Atrial Fibrillation

et al. 2021

Observational studies have shown an association between hypertension and atrial fibrillation (AF). Aggressive blood pressure management in patients with known AF reduces overall arrhythmia burden, but it remains unclear whether hypertension is causative for AF. To address this question, this study explored the relationship between genetic predictors of blood pressure and risk of AF. We secondarily explored the relationship between genetically proxied use of antihypertensive drugs and risk of AF. Two-sample Mendelian randomization was performed using an inverse-variance weighted meta-analysis with weighted median Mendelian randomization and Egger intercept tests performed as sensitivity analyses. Summary statistics for systolic blood pressure, diastolic blood pressure, and pulse pressure were obtained from the International Consortium of Blood Pressure and the UK Biobank discovery analysis and AF from the 2018 Atrial Fibrillation Genetics Consortium multiethnic genome-wide association studies. Increases in genetically proxied systolic blood pressure, diastolic blood pressure, or pulse pressure by 10 mm Hg were associated with increased odds of AF (systolic blood pressure: odds ratio [OR], 1.17 [95% CI, 1.11–1.22]; P =1×10 −11 ; diastolic blood pressure: OR, 1.25 [95% CI, 1.16–1.35]; P =3×10 −8 ; pulse pressure: OR, 1.1 [95% CI, 1.0–1.2]; P =0.05). Decreases in systolic blood pressure by 10 mm Hg estimated by genetic proxies of antihypertensive medications showed calcium channel blockers (OR, 0.66 [95% CI, 0.57–0.76]; P =8×10 −9 ) and β-blockers (OR, 0.61 [95% CI, 0.46–0.81]; P =6×10 −4 ) decreased the risk of AF. Blood pressure–increasing genetic variants were associated with increased risk of AF, consistent with a causal relationship between blood pressure and AF. These data support the concept that blood pressure reduction with calcium channel blockade or β-blockade could reduce the risk of AF.