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Factors Modifying the Risk of Atrial Fibrillation Associated With Atrial Premature Complexes in Patients With Hypertension.

高血压患者心房纤颤风险的影响因素.

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.02.006
  • 作者列表:"Soliman EZ","Howard G","Judd S","Bhave PD","Howard VJ","Herrington DM
  • 发表时间:2020-05-01
Abstract

:Patients with hypertension who develop atrial premature complexes (APCs) are at a particularly high risk for atrial fibrillation (AF). We sought to identify medications and modifiable risk factors that could reduce the risk of AF imposed by presence of APCs in such a high risk group. This analysis included 4,331 participants with treated hypertension from the Reasons for Geographic and Racial Differences in Stroke study who were free of AF and cardiovascular disease at the time of enrollment (2003-2007). APCs were detected in 8.2% (n = 356) of the participants at baseline. During a median follow-up of 9.4 years, 9.9% (n = 429) of the participants developed AF. Participants with APCs, compared with those without, were more than twice as likely to develop AF (Odds ratio [95% confidence interval]: 2.36[1.75, 3.19]). This association was significantly weaker in statin users than nonusers (Odds ratio [95% confidence interval]:1.42[0.81,2.48] vs 3.01[2.11,4.32], respectively; interaction p-value = 0.02), and in angiotensin-II receptor blocker users than nonusers (Odds ratio [95% confidence interval]:1.31[0.66,2.61] vs 2.78[1.99,3.89], respectively; interaction p-value = 0.05). Borderline weaker associations between APCs and AF were also observed in alpha-blocker users than nonusers, nondiabetics than diabetics, and in those with systolic blood pressure level 130 to 139 mm Hg compared with those with other systolic blood pressure levels. No significant effect modifications were observed by use of other medications or by presence of other cardiovascular risk factors. In conclusion, the significant AF risk associated with APCs in patients with hypertension could potentially be reduced by treatment with angiotensin-II receptor blockers and statins along with lowering blood pressure and management of diabetes.

摘要

: 发生房性期前收缩综合征 (apc) 的高血压患者发生心房颤动 (AF) 的风险特别高。我们试图确定药物和可改变的风险因素,这些因素可以降低如此高风险组中apc存在所带来的AF风险。该分析纳入了4,331名接受治疗的高血压参与者,这些参与者在纳入研究时 (2003-2007) 没有房颤和心血管疾病,原因是卒中研究中的地理和种族差异。基线时在8.2% (n = 356) 的参与者中检测到apc。在中位随访9.4年期间,9.9% (n = 429) 的参与者发生了房颤。与无apc的参与者相比,有apc的参与者发生AF的可能性是前者的两倍多 (比值比 [95% 置信区间]: 2.36[1.75,3.19])。他汀类药物使用者的这种相关性显著弱于非使用者 (比值比 [95% 置信区间]: 分别为1.42[0.81,2.48] 和3.01[2.11,4.32]; 交互作用p值   = 0.02),血管紧张素II受体阻滞剂使用者多于非使用者 (比值比 [95% 置信区间]: 分别为1.31[0.66,2.61] 和2.78[1.99,3.89]; 相互作用p值   = 0.05)。在使用 α 受体阻滞剂的人群中,与未使用 α 受体阻滞剂的人群相比,在糖尿病患者中,与其他收缩压水平的人群相比,收缩压水平为130 ~ 139毫米mmhg的人群中,APCs与房颤之间的相关性也呈边缘较弱.通过使用其他药物或通过存在其他心血管危险因素,未观察到显著的效果改变。总之,高血压患者中与apc相关的显著AF风险可能通过血管紧张素II受体阻滞剂和他汀类药物治疗以及降低血压和控制糖尿病来潜在地降低。

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心律失常方向

心律失常(arrhythmia)是由于窦房结激动异常或激动产生于窦房结以外,激动的传导缓慢、阻滞或经异常通道传导,即心脏活动的起源和(或)传导障碍导致心脏搏动的频率和(或)节律异常。心律失常是心血管疾病中重要的一组疾病,可单独发病,亦可与其他心血管病伴发。其预后与心律失常的病因、诱因、演变趋势、是否导致严重血流动力障碍有关,可突然发作而致猝死,亦可持续累及心脏而致其衰竭。

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