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


  • 影响因子:0
  • 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

: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.


: 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。



作者列表:["Meng L","Bai X","Zheng Y","Chen D","Zheng Y"]

METHODS::Aim: We explored the role of histone modification in the association of depression-hypertension by comparing norepinephrine transporter (NET) gene levels in different depression-hypertensive patients. Then, we analyzed the expression of NET correlation with inflammatory cytokines to provide a new direction for detecting the association mechanism between depression and hypertension.Methods: NE expression levels in serum of diverse groups were detected by enzyme-linked immunosorbent assay. Then histone acetyltransferase (HAT), histone deacetylase (HDAC), H3K27ac, NET, TNF-α, and interleukin-6 (IL-6) were detected by western blot in nine female subjects in different depression and hypertension groups, and Chromatin immunoprecipitation-polymerase chain reaction (Chip-PCR) were used to confirm the degree of acetylation affecting on the transcription level of NET gene. Meanwhile, correlation between NET with TNF/IL-6 was analyzed by SPSS19.0 software program. Finally, Quantitative real-time polymerase chain reaction (qPCR) and western blot were used to detect TNF-α and IL-6 expression levels after NET overexpression or interference treatment in human umbilical vein endothelial cells and Neuro-2a cells.Results: The expression of HAT and H3K27ac had lower levels in D-H and nonD-H group than nonD-nonH group. The results showed that higher acetylation could promote expression of NET genes. Meanwhile, the expression of NET had a significant negative correlation with IL-6 (R = -0.933, p < 0.01) and tumor necrosis factor (TNF) (R = -0.817, p < 0.01) in subjects. In addition, the results confirmed that TNF-α and IL-6 mRNA and protein partial expressions could be inhibited by NET in both HUVECs and Neuronal cells (p < 0.01).Conclusion: In conclusion, differential expression of NET gene might function as an important factor in interaction between depression and hypertension by partially targeting TNF-α and IL-6.

翻译标题与摘要 下载文献
作者列表:["Dugani SB","Murad W","Damilig K","Atos J","Mohamed E","Callachan E","Farukhi Z","Shaikh A","Elfatih A","Yusef S","Hydoub YM","Moorthy MV","Mora B","Alawadhi A","Issac R","Saleh A","Al-Mulla A","Mora S","Alsheikh-Ali AA"]

METHODS::The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case-control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.

作者列表:["Göpel W","Müller M","Rabe H","Borgmann J","Rausch TK","Faust K","Kribs A","Dötsch J","Ellinghaus D","Härtel C","Roll C","Szabo M","Nürnberg P","Franke A","König IR","Turner MA","Herting E"]

METHODS:OBJECTIVE:The aim of our study was to determine if a genetic background of high blood pressure is a survival factor in preterm infants. DESIGN:Prospective cohort study. SETTING:Patients were enrolled in 53 neonatal intensive care units. PATIENTS:Preterm infants with a birth weight below 1500 g. EXPOSURES:Genetic score blood pressure estimates were calculated based on adult data. We compared infants with high genetic blood pressure estimates (>75th percentile of the genetic score) to infants with low genetic blood pressure estimates (<25th percentile of the genetic score). MAIN OUTCOME MEASURES:Lowest blood pressure on the first day of life and mortality. RESULTS:5580 preterm infants with a mean gestational age of 28.1±2.2 weeks and a mean birth weight of 1022±299 g were genotyped and analysed. Infants with low genetic blood pressure estimates had significantly lower blood pressure if compared with infants with high genetic blood pressure estimates (27.3±6.2vs 27.9±6.4, p=0.009, t-test). Other risk factors for low blood pressure included low gestational age (-1.26 mm Hg/week) and mechanical ventilation (-2.24 mm Hg, p<0.001 for both variables, linear regression analysis). Mortality was significantly reduced in infants with high genetic blood pressure estimates (28-day mortality: 21/1395, 1.5% vs 44/1395, 3.2%, p=0.005, Fisher's exact test). This survival advantage was independent of treatment with catecholamines. CONCLUSIONS:Our study provides first evidence that a genetic background of high blood pressure may be beneficial with regard to survival of preterm infants.

翻译标题与摘要 下载文献