Antihypertensive therapy prevents new-onset atrial fibrillation in patients with isolated systolic hypertension: the LIFE study

Figures & data

Table 1. Baseline demographic and clinical characteristics in relation to new-onset atrial fibrillation in 1248 patients with isolated systolic hypertension.

Variables	Sinus rhythm (n = 1187)	New-onset atrial fibrillation (n = 61)	p Value
Age, year	70.1 (6.4)	71.9 (5.4)	0.03
Sex, % female	60.6	52.5	0.21
Race, % black	6.5	1.6	0.17
Treatment with losartan, %	50.9	36.1	0.02
Diabetes, %	17.3	14.8	0.61
History of ischaemic heart disease, %	19.6	23.0	0.53
History of myocardial infarction, %	8.5	9.8	0.72
History of heart failure, %	2.1	4.9	0.15
History of cerebrovascular disease, %	11.4	11.5	0.98
History of TIA, %	5.8	4.9	1.00
History of peripheral vascular disease, %	8.1	6.6	0.81
Current smokers, %	15.4	6.7	0.06
Weight, kg	75.1 (14.7)	77.1 (13.7)	0.31
Height, cm	165.2 (9.3)	167.9 (8.6)	0.03
Body mass index, kg/m^2	27.5 (4.9)	27.4 (4.9)	0.89
Systolic blood pressure, mmHg	174.1 (10.8)	179.0 (11.5)	0.001
Diastolic blood pressure, mmHg	82.7 (5.8)	83.4 (4.8)	0.34
Pulse pressure, mmHg	91.4 (11.7)	95.6 (11.1)	0.01
Heart rate, beats/min	71.7 (10.8)	70.8 (11.3)	0.53
Sokolow-Lyon voltage, mm	30.8 (10.2)	33.7 (12.0)	0.03
Cornell voltage-duration product, mm × ms	2772 (1053)	2920 (1063)	0.29
Hemoglobin, mmol/L	138.9 (12.4)	138.8 (13.0)	0.97
Sodium, mmol/L	140.3 (2.7)	140.4 (2.3)	0.91
Potassium, mmol/L	4.2 (0.4)	4.1 (0.4)	0.02
Creatinine, mmol/L	88.0 (21.1)	84.0 (16.0)	0.15
Total cholesterol, mmol/L	5.98 (1.15)	5.89 (1.08)	0.56
HDL cholesterol, mmol/L	1.49 (0.44)	1.52 (0.44)	0.64
Uric acid, μmol/L	324 (77)	329 (77)	0.58
Glucose, mmol/L	6.22 (2.46)	6.17 (2.14)	0.90
Urine albumin/creatinine ratio, mg/µmol	6.2 (22.2)	5.2 (12.5)	0.74
Framingham risk score, %	23.1 (9.9)	24.0 (9.8)	0.47

Data are presented as mean (SD) unless otherwise indicated. Abbreviations: TIA: transitory ischaemic attack; HDL: high density lipoprotein.

Table 2. Predictors of new-onset atrial fibrillation in 1248 patients with isolated systolic hypertension.

Univariate predictor variable	Hazard ratio (95 % CI)	p Value
Baseline systolic BP (per 1 mmHg increase)	1.04 (1.01–1.06)	0.001
Height (per 1 cm increase)	1.04 (1.01–1.06)	0.014
Baseline Sokolow-Lyon (per 10.5 mm increase)	1.36 (1.06–1.75)	0.015
Potassium (per 1 mmol/L increase)	0.39 (0.18–0.86)	0.019
Treatment (atenolol vs. losartan)	1.84 (1.09–3.11)	0.022
Time-varying heart rate (per 1 beat/min increase)	1.025 (1.003–1.047)	0.023
Age (per 1 year increase)	1.05 (1.01–1.10)	0.029
Smoking (yes vs. no)	0.41 (0.15–1.14)	0.087
Time-varying Cornell product (per 1050 mm × ms increase)	1.17 (0.96–1.43)	0.11
Gender (male vs. female)	1.49 (0.90–2.48)	0.12

Figure 1. Flow chart of the patients who participated in the present study.

Figure 2. Development of systolic blood pressure (Figure 2a, upper panel) and diastolic blood pressure (Figure 2b, lower panel) in the ISH patients and the non-ISH patients who had incident AF and the patients who did not have incident AF. The y-axes have been truncated.

Figure 3. Cornell product as indicator of ECG-LVH at baseline and yearly during the study in the ISH patients and the non-ISH patients with new-onset AF (upper lines) and in patients without new-onset AF during the study (lower lines). The y-axis has been truncated.

Table 3. Predictors of new-onset atrial fibrillation in 7583 patients with non-isolated systolic hypertension.

Univariate predictor variable	Hazard ratio (95 % CI)	p Value
Age (per 1 year increase)	1.10 (1.08–1.12)	<0.001
Baseline pulse pressure (per 1 mmHg increase)	1.02 (1.01–1.03)	<0.001
Framingham risk score (per 1 percentage point increase)	1.02 (1.01–1.03)	<0.001
Time-varying heart rate (per 1 beat/min increase)	1.03 (1.02–1.04)	<0.001
Log urine albumin-creatinine ratio (mg/mmol)	1.39 (1.17–1.65)	<0.001
Time-varying Cornell product (per 1050 mm × ms increase)	1.17 (1.06–1.29)	0.001
Baseline systolic BP (per 1 mmHg increase)	1.01 (1.00–1.02)	0.002
Treatment (atenolol vs. losartan)	1.43 (1.13–1.80)	0.003
Baseline Cornell product (per 1050 mm × ms increase)	1.16 (1.05–1.28)	0.005
Race (black)	0.31 (0.13–0.74)	0.009
Baseline cholesterol (per 1 mmol/L increase)	0.88 (0.79–0.98)	0.015
Baseline diastolic BP (per 1 mmHg increase)	0.98 (0.96–0.99)	0.036
Gender (male vs. female)	0.81 (0.64–1.02)	0.066
History of coronary artery disease (yes vs. no)	1.27 (0.94–1.72)	0.120

Table 4. Time dependent (time to event) multivariate Cox regression analyses to assess the risk of incident atrial fibrillation related to in-treatment variation of 10 mmHg in systolic BP in patients with isolated systolic hypertension and non- isolated systolic hypertension.

In-treatment SBP per 10 mmHg decrease	ISH (n = 1248)			Non-ISH (n = 7583)
	Hazard ratio	95 % CI	p Value	Hazard ratio	95 % CI	p Value
Univariate	0.87	0.75–1.01	0.070	0.96	0.89–1.02	0.19
Adjusted for treatment	0.87	0.76–1.01	0.066	0.95	0.89–1.02	0.16
Adjusted for baseline SBP	0.82	0.71–0.95	0.008	0.92	0.86–0.99	0.023
Multivariate Model 1	0.87	0.75–1.00	0.054	0.93	0.87–1.00	0.043
Multivariate Model 2	0.83	0.73–0.95	0.008	0.91	0.85–0.97	0.006

Model 1: Adjusted for treatment effect, Framingham risk score, history of coronary heart disease, and in-treatment heart rate and in-treatment ECG-LVH determined by Cornell voltage-duration product.

Model 2: Adjusted for baseline SBP, treatment effect, Framingham risk score, history of coronary heart disease, and in-treatment heart rate and in-treatment ECG-LVH determined by Cornell voltage-duration product.

Table 5. Time dependent (time to event) multivariate Cox regression analyses to assess the risk of the combined end point of incident atrial fibrillation or all-cause mortality related to in-treatment variation of 10 mmHg in systolic BP in patients with isolated systolic hypertension and non-isolated systolic hypertension.

In-treatment SBP per 10 mmHg decrease	ISH (n = 1248)			Non-ISH (n = 7583)
	Hazard ratio	95 % CI	p Value	Hazard ratio	95 % CI	p Value
Univariate	0.91	0.84–0.98	0.015	0.89	0.86–0.93	<0.001
Adjusted for treatment	0.92	0.85–0.99	0.021	0.90	0.86–0.93	<0.001
Adjusted for baseline SBP	0.94	0.87–1.02	0.133	0.91	0.88–0.95	<0.001
Multivariate Model 1	0.91	0.84–0.98	0.014	0.92	0.89–0.96	<0.001
Multivariate Model 2	0.93	0.87–1.01	0.087	0.93	0.89–0.96	<0.001

Model 1: Adjusted for treatment effect, Framingham risk score, history of coronary heart disease, and in-treatment heart rate and in-treatment ECG-LVH determined by Cornell voltage-duration product.

Model 2: Adjusted for baseline SBP, treatment effect, Framingham risk score, history of coronary heart disease, and in-treatment heart rate and in-treatment ECG-LVH determined by Cornell voltage-duration product.