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

Abstract

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.

Optimizing indices of atrial fibrillation susceptibility and burden to evaluate atrial fibrillation severity, risk and outcomes

“…To date, BP is related to the risk of incident AF by a U-shaped relation, in which the lowest risk for new AF may be obtained through BP levels <130/80 mmHg in patients under 80 compared to less severe thresholds in those aged >80. 88 Being an end-product of the hypertensive state, left ventricular (LV) hypertrophy (LVH) has also been identified as a predictor of new AF in many registries. 89 Although the prevalence of LVH in the hypertensive population broadly varies among studies according to different diagnostic criteria adopted, AF prevalence seems to be higher in patients with more severe ventricular remodelling (especially in the case of concentric and eccentric hypertrophy).…”

Association of proteinuria and hypertension with incident atrial fibrillation in an elderly population: nationwide data from a community-based elderly cohort

“…Hypertension is the most common risk factor of incident atrial fibrillation [ 8 , 19 ], and increased blood pressure is associated with a greater burden of atrial fibrillation [ 5 , 6 ]. Atrial fibrillation is not only related with impaired quality of life because of more hospitalizations and cognitive impairment but also is associated with a substantial risk of mortality and morbidity resulting from stroke and congestive heart failure [ 1 , 3 , 13 ].…”

“…Hypertension is highly prevalent in populations with atrial fibrillation and provides the highest attributable risk for the development of atrial fibrillation [ 4 ]. Patients with poorly controlled blood pressure (BP) have an associated increased risk of incident atrial fibrillation [ 5 , 6 ] and the development of adverse cardiovascular outcomes [ 7 ]. However, hypertension rarely occurs as an isolated disorder and is often accompanied by a number of comorbidities that are indicative of signs of target organ damage because of elevated BP [ 8 ].…”

New Perspective in Atrial Fibrillation

“…Indeed, apart from the pulmonary vein triggers that have been extensively studied [4], the relationship between other triggers (inflammation as in acute AF [5][6][7], stable coronary artery disease [8], or post-operative AF [9]), the modulator (mainly autonomic nervous system dysregulation [10]) and substrate alterations (fibrosis but also changes in the conduction properties of the atrial cells even in the absence of a quantifiable "scar" [11]) have been recently brought to light by several papers [12,13]. The interplay between cardiovascular risk factors, mainly high blood pressure [14] and obesity [6], atrial epicardial fat, and atrial ganglionated plexi [15], is complex and critical for the understanding of AF, but also in the search for new treatments. In this regard, a particular focus should be placed on the new anti-diabetic therapies (SGLT-2 inhibitors [16] and GLP-1 receptor agonists [17]) that have not only proven a benefit for major cardiovascular events (MACE) occurrence but also a decrease in AF burden.…”