TY - JOUR
T1 - Relation of Orthostatic Hypotension With New-Onset Atrial Fibrillation (From the Framingham Heart Study)
AU - Ko, Darae
AU - Preis, Sarah R.
AU - Lubitz, Steven A.
AU - McManus, David D.
AU - Vasan, Ramachandran S.
AU - Hamburg, Naomi M.
AU - Benjamin, Emelia J.
AU - Mitchell, Gary F.
N1 - Funding Information:
Dr. Lubitz has received grant funding from Boehringer Ingelheim to test electronic notification methods to improve adherence to guideline-directed anticoagulation and has received consulting support from St. Jude Medical for the use of implantable atrial fibrillation detection technologies. Dr. McManus has consulted and/or received grant from Bristol-Myers Squibb, Pfizer, Philips, Samsung Semiconductor, and Biotronik, Inc. He is an equity stakeholder in MobileSense Technologies, Inc. Dr. Mitchell has consulted for Servier, Merck, Philips Healthcare, and Novartis. He is an owner of Cardiovascular Engineering, Inc, a company that designs and manufactures devices that measure vascular stiffness.
Funding Information:
Funding: This work was supported by the Boston University School of Medicine and the National Heart, Lung, and Blood Institute's Framingham Heart Study (contract N01-HC-25195; HHSN268201500001I) and the Division of Intramural Research of the National Heart, Lung, and Blood Institute. Additional support for this project was from the National Institutes of Health 5T32HL007224-41 (Ko); K23HL114724 (Lubitz); KL2RR031981, 1R01HL126911-01A1 (McManus); 2R01HL092577, 1R01HL128914, 1P50HL120163 (Benjamin); 4R01HL115391 (Hamburg); 5R01HL107385 and R01HL126136 (Vasan); grant 2014105 from the Doris Duke Charitable Foundation (Lubitz).
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Previous studies have reported that orthostatic hypotension (OH) is associated with increased risk of atrial fibrillation (AF). We sought to determine whether the association persists after adjusting for hypertension and other cardiovascular risk factors. We studied the Framingham Heart Study Original cohort participants evaluated between 1981 and 1984 without baseline AF. OH was defined as drop in standing systolic blood pressure (BP) of at least 20 mm Hg or standing diastolic BP of at least 10 mm Hg from their supine values after standing for 2 minutes. We estimated Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HR) for association between OH and risk of incident AF, adjusting for age, sex, seated systolic BP and diastolic BP, resting heart rate, height, weight, current tobacco use, hypertension treatment, diabetes, and history of myocardial infarction and heart failure. Of 1,736 participants (mean age, 71.7 ± 6.5 years, 60% women), 256 (14.8%) had OH at baseline. During 10 years of follow-up, 224 participants developed new AF. In our multivariable-adjusted model, OH (HR 1.61, 95% confidence interval 1.17 to 2.20) and greater orthostatic decrease in mean arterial pressure (MAP) (HR 1.11, 95% confidence interval 1.02 to 1.22 per 8.6 mm Hg change in MAP) were both associated with higher risk of new AF. In conclusion, in our longitudinal community-based sample, OH and orthostatic decline in MAP were significantly associated with increased risk of incident AF after adjustment for systolic BP, diastolic BP, and hypertension treatment.
AB - Previous studies have reported that orthostatic hypotension (OH) is associated with increased risk of atrial fibrillation (AF). We sought to determine whether the association persists after adjusting for hypertension and other cardiovascular risk factors. We studied the Framingham Heart Study Original cohort participants evaluated between 1981 and 1984 without baseline AF. OH was defined as drop in standing systolic blood pressure (BP) of at least 20 mm Hg or standing diastolic BP of at least 10 mm Hg from their supine values after standing for 2 minutes. We estimated Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HR) for association between OH and risk of incident AF, adjusting for age, sex, seated systolic BP and diastolic BP, resting heart rate, height, weight, current tobacco use, hypertension treatment, diabetes, and history of myocardial infarction and heart failure. Of 1,736 participants (mean age, 71.7 ± 6.5 years, 60% women), 256 (14.8%) had OH at baseline. During 10 years of follow-up, 224 participants developed new AF. In our multivariable-adjusted model, OH (HR 1.61, 95% confidence interval 1.17 to 2.20) and greater orthostatic decrease in mean arterial pressure (MAP) (HR 1.11, 95% confidence interval 1.02 to 1.22 per 8.6 mm Hg change in MAP) were both associated with higher risk of new AF. In conclusion, in our longitudinal community-based sample, OH and orthostatic decline in MAP were significantly associated with increased risk of incident AF after adjustment for systolic BP, diastolic BP, and hypertension treatment.
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U2 - 10.1016/j.amjcard.2017.11.036
DO - 10.1016/j.amjcard.2017.11.036
M3 - Article
C2 - 29290367
AN - SCOPUS:85041680267
VL - 121
SP - 596
EP - 601
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 5
ER -