Cardiovasc Diabetol. 2023;22(1):12.

Accumulated hypertension burden on atrial fibrillation risk in diabetes mellitus: a nationwide population study.

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제1저자 최정민, 이소령 · 교신저자 최의근

PMID 36658574 PMC9854085 DOI 10.1186/s12933-023-01736-4 IF 15.6 순환기내과

소속 (8)

Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. choiek17@snu.ac.kr.
Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea. choiek17@snu.ac.kr.
Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Chest & Heart Hospital, Liverpool, UK.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

BACKGROUND Patients with diabetes mellitus have an increased risk of incident atrial fibrillation (AF). The effect of accumulated hypertension burden is a less well-known modifiable risk factor. We explored the relationship between accumulated hypertension burden and incident AF in these patients.

METHODS We evaluated data for 526,384 patients with diabetes who underwent three consecutive health examinations, between 2009 and 2012, from the Korean National Health Insurance Service. Hypertension burden was calculated by assigning points to each stage of hypertension in each health examination: 1 for stage 1 hypertension (systolic blood pressure [SBP] 130-139 mmHg; diastolic blood pressure [DBP] 80-89 mmHg); 2 for stage 2 (SBP 140-159 mmHg and DBP 90-99 mmHg); and 3 for stage 3 (SBP ≥ 160 mmHg or DBP ≥ 100 mmHg). Patients were categorized into 10 hypertensive burden groups (0-9). Groups 1-9 were then clustered into 1-3, 4-6, and 7-9.

RESULTS During a mean follow-up duration of 6.7 ± 1.7 years, AF was newly diagnosed in 18,561 (3.5%) patients. Compared to patients with hypertension burden 0, those with burden 1 to 9 showed a progressively increasing risk of incident AF: 6%, 11%, 16%, 24%, 28%, 41%, 46%, 57%, and 67% respectively. Clusters 1-3, 4-6, and 7-9 showed increased risks by 10%, 26%, and 45%, respectively, when compared to a hypertension burden of 0.

CONCLUSIONS Accumulated hypertension burden was associated with an increased risk of incident AF in patients with diabetes. Strict BP control should be emphasized for these patients.

Keywords

Atrial fibrillationCardiovascular complicationsHypertensionType 1 diabetesType 2 diabetes

Figures

**Fig. 1** Study design. Abbreviation: AF, atrial fibrillation; BP, blood pressure; Exam, examination; Gr, grade; HTN, hypertension; Ref, reference

**Fig. 2** Cumulative incidence curves of AF stratified by hypertension burden; A group of 10 and B group of 4. Abbreviation: AF, atrial fibrillation; HTN, hypertension

**Fig. 3** Association between cumulative hypertension burden and incident AF in diabetic subjects; A group of 10 B group of 4. Abbreviation: AF, atrial fibrillation; CI, confidence interval

그림 출처: PubMed Central 공개 논문 (PMC9854085)

Conflict of interest statement

EKC: Research grants or speaking fees from Abbott, Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daewoong Pharmaceutical Co., Daiichi-Sankyo, DeepQure, Dreamtech Co., Ltd., Jeil Pharmaceutical Co. Ltd, Medtronic, Samjinpharm, Seers Technology, and Skylabs. GYHL: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo. No fees were received personally by any author. The remaining authors have nothing to disclose.

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