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Orthostatic hypotension increased risk for AF
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Patients with orthostatic hypotension were more likely to develop atrial fibrillation during 18 years of follow-up compared with those without hypotension, researchers reported in a recent study.
The study was designed to evaluate changes in BP moving from the supine to standing position. Researchers enrolled 12,071 adults aged 45 to 64 years who were participants in the ARIC study. Patients with a decrease of ≥20 mm Hg in systolic BP or ≥10 mm Hg in diastolic BP from supine to standing were classified as having orthostatic hypotension.
At baseline, 603 patients had orthostatic hypotension. During mean follow-up of 18 years, 11.9% of the cohort developed AF. AF was significantly more common among patients with orthostatic hypotension compared with no hypotension after adjustment for age (9.3 cases per 1,000 person-years vs. 6.3 cases per 1,000 person-years; P<.001). Researchers calculated an HR for AF of 2.22 (95% CI, 1.8-2.65) among those with hypotension compared with those without hypotension. Adjustment for age, sex, race and location reduced this risk (adjusted HR=1.62; 95% CI, 1.34-2.14); additional adjustment for common risk factors for AF further attenuated the association (HR=1.4, 95% CI, 1.15-1.71). Exclusion of patients with CHD, diabetes or hypertension did not significantly alter the results.
The link between orthostatic hypotension and AF was more pronounced among patients taking medications that increased hypotension risk (HR=1.66; 95% CI, 1.26-2.19 among recipients; HR=1.08; 95% CI, 0.76-1.54 among non-recipients). The association also was stronger among women compared with men.
Researchers observed a nonlinear association between change in systolic BP and incident AF after adjusting for confounders. Patients with a change in systolic BP of ≥19 mm Hg were at increased risk for AF compared with those with a BP change between the 5th and 95th percentile (HR=1.58; 95% CI, 1.3-1.91). Those with a change of ≥16 mm Hg were not at increased risk (HR=1.13; 95% CI, 0.9-1.41).
“We found that orthostatic hypotension, a simple clinical measurement, is associated with an elevated AF risk by 40% during an average follow-up of 18 years,” the researchers concluded. “The strength of this relationship is similar to that of diabetes or hypertension with AF. Future studies examining mechanisms linking orthostatic change in BP with AF, including a closer look at autonomic function by measures such as heart rate variability, may improve our understanding.”
Disclosure: The researchers report no relevant financial disclosures.
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