Associated factors and effects of comorbid atrial fibrillation in hypertensive patients due to primary aldosteronism
Associated factors and effects of comorbid atrial fibrillation in hypertensive patients due to primary aldosteronism
复制标题
原发性醛固酮增多症高血压患者合并房颤的相关因素及影响
DOI：
10.1038/s41371-022-00753-2
复制
发表时间：
2023
影响因子：
2.7
通讯作者：
Dohi K; JRAS investigators; Naruse M.
中科院分区：
文献类型：
--
作者：
Sakaguchi S;Okamoto R;Inoue C;Akao M;Kamemura K;Kurihara I;Takeda Y;Ohno Y;Inagaki N;Rakugi H;Katabami T;Tsuiki M;Tanabe A;Tamura K;Fujita S;Yano Y;Dohi K; JRAS investigators; Naruse M.
据报道，原发性醛固酮增多症（PA）患者心房颤动（AF）的发生率和心血管事件的风险高于原发性高血压。然而，PA治疗后并发房颤和心血管事件的相关因素尚不清楚。这项全国性的登记研究纳入了年龄≥20岁的PA患者。平均随访约3年，观察心血管事件的发生。分析时共纳入3654例PA患者。房颤患病率为2.4%。合并房颤的PA患者年龄较大，男性居多，高血压持续时间较无房颤的患者长。两组间在基础血浆和肾上腺静脉醛固酮浓度、肾素活性、钾浓度、PA确证试验、侧侧性及手术率方面均无显著差异。Logistic回归分析显示，年龄、男性、心胸比、既往冠状动脉疾病史和心力衰竭是与房颤相关的独立因素，PA合并房颤患者发生心血管事件的频率高于无房颤患者（P< 0.001）。多因素Cox分析显示，房颤、年龄、高血压病程、体重指数和慢性肾脏疾病是PA治疗后心血管事件的独立预后因素。在调整年龄、性别和收缩压后的随访中，PA合并房颤患者的心血管事件发生率明显低于Fushimi登记的房颤患者。早期诊断PA可以通过缩短高血压病程和适当的PA治疗来预防AF和其他心血管事件。
The incidence of atrial fibrillation (AF) and risk of cardiovascular events are reportedly higher in patients with primary aldosteronism (PA) than essential hypertension. However, associated factors of comorbid AF and cardiovascular events in PA patients after PA treatment remain unclear. This nationwide registration study included PA patients ≥20 years old. Incident cardiovascular events were observed with a mean follow-up of approximately 3 years. A total of 3654 patients with PA were included at the time of analysis. Prevalence of AF was 2.4%. PA patients with AF were older, more frequently male and had longer duration of hypertension than those without AF. No significant difference in basal plasma and adrenal venous aldosterone concentration, renin activity, potassium concentration, confirmatory tests of PA, laterality or surgery rate were seen between groups. Logistic regression analysis showed age, male sex, cardiothoracic ratio, past history of coronary artery disease and heart failure were independent factors associated with AF. PA patients with AF showed a higher frequency of cardiovascular events than those without AF (P< 0.001). Multivariate Cox analyses demonstrated AF in addition to older age, duration of hypertension, body mass index and chronic kidney disease as independent prognostic factors for cardiovascular events after PA treatment. Incidence of cardiovascular events were significantly lower in PA patients with AF than AF patients from the Fushimi registry during follow-up after adjusting age, sex and systolic blood pressure. Early diagnosis of PA may prevent AF and other cardiovascular events in PA patients by shortening the duration of hypertension and appropriate PA treatment.