Usual blood pressure, atrial fibrillation and vascular risk: evidence from 4.3 million adults.
Usual blood pressure, atrial fibrillation and vascular risk: evidence from 4.3 million adults.
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DOI：
10.1093/ije/dyw053
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发表时间：
2017-02-01
影响因子：
7.7
通讯作者：
Rahimi K
中科院分区：
文献类型：
--
作者：
Emdin CA;Anderson SG;Salimi-Khorshidi G;Woodward M;MacMahon S;Dwyer T;Rahimi K
背景：尽管血压升高与房颤(AF)风险增加有关，但这种关联是否因个体特征而异尚不清楚。此外，房颤与一系列不同血管事件之间的关联还有待可靠的量化。方法：使用链接的电子健康记录，我们检查了英国430万名30至90岁的成年人中首次诊断房颤的时间和首次诊断9个血管事件的时间。结果：正常收缩压越高，发生房颤的风险越高[危险比(HR)1.21，95%可信区间(CI)1.19，1.22]。这种联系的强度随着年龄的增长而下降，从30-40岁的HR 1.91(CI 1.75，2.09)下降到80-90岁的HR 1.01(CI 0.97，1.04)。未使用抗血栓药物的房颤与使用抗血栓药物的房颤相比，发生任何血管事件的风险更大(P交互作用&t；0.0001)。未使用抗血栓药物的房颤与缺血性心脏病(HR 2.52，CI 2.23，2.84)、心力衰竭(HR 3.80，CI 3.50，4.12)、缺血性卒中(HR 2.72，CI 2.19，3.38)、不明原因卒中(HR 2.59，CI 2.25，2.99)、出血性卒中、慢性肾脏疾病、外周动脉疾病和血管性痴呆的风险增加相关，但与主动脉瘤无关。结论：血压升高和房颤之间的关联随着年龄的增长而减弱。未使用抗血栓药物的房颤与发生八种血管事件的风险增加有关。
Background: Although elevated blood pressure is associated with an increased risk of atrial fibrillation (AF), it is unclear if this association varies by individual characteristics. Furthermore, the associations between AF and a range of different vascular events are yet to be reliably quantified. Methods: Using linked electronic health records, we examined the time to first diagnosis of AF and time to first diagnosis of nine vascular events in a cohort of 4.3 million adults, aged 30 to 90 years, in the UK. Results: A 20-mmHg higher usual systolic blood pressure was associated with a higher risk of AF [hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.19, 1.22]. The strength of the association declined with increasing age, from an HR of 1.91 (CI 1.75, 2.09) at age 30-40 to an HR of 1.01 (CI 0.97, 1.04) at age 80-90 years. AF without antithrombotic use at baseline was associated with a greater risk of any vascular event than AF with antithrombotic usage (P interaction < 0.0001). AF without baseline antithrombotic usage was associated with an increased risk of ischaemic heart disease (HR 2.52, CI 2.23, 2.84), heart failure (HR 3.80, CI 3.50, 4.12), ischaemic stroke (HR 2.72, CI 2.19, 3.38), unspecified stroke (HR 2.59, CI 2.25, 2.99), haemorrhagic stroke, chronic kidney disease, peripheral arterial disease and vascular dementia, but not aortic aneurysm. Conclusions: The association between elevated blood pressure and AF attenuates with increasing age. AF without antithrombotic usage is associated with an increased risk of eight vascular events.