Dataset Information

Blood Pressure and Brain Lesions in Patients With Atrial Fibrillation.

ABSTRACT: The association of blood pressure (BP) and hypertension with the presence of different types of brain lesions in patients with atrial fibrillation is unclear. BP values were obtained in a multicenter cohort of patients with atrial fibrillation. Systolic and diastolic BP was categorized in predefined groups. All patients underwent brain magnetic resonance imaging and neurocognitive testing. Brain lesions were classified as large noncortical or cortical infarcts, small noncortical infarcts, microbleeds, or white matter lesions. White matter lesions were graded according to the Fazekas scale. Overall, 1738 patients with atrial fibrillation were enrolled in this cross-sectional analysis (mean age, 73 years, 73% males). Mean BP was 135/79 mm?Hg, and 67% of participants were taking BP-lowering treatment. White matter lesions Fazekas ?2 were found in 54%, large noncortical or cortical infarcts in 22%, small noncortical infarcts in 21%, and microbleeds in 22% of patients, respectively. Compared with patients with systolic BP <120 mm?Hg, the adjusted odds ratios (95% CI) for Fazekas?2 was 1.25 (0.94-1.66), 1.41 (1.03-1.93), and 2.54 (1.65-3.95) among patients with systolic BP of 120 to 140, 140 to 160, and ?160 mm?Hg (P for linear trend<0.001). Per 5 mm?Hg increase in systolic and diastolic BP, the adjusted ?-coefficient (95% CI) for log-transformed white matter lesions was 0.04 (0.02-0.05), P<0.001 and 0.04 (0.01-0.06), P=0.004. Systolic BP was associated with small noncortical infarcts (odds ratios [95% CI] per 5 mm?Hg 1.05 [1.01-1.08], P=0.006), microbleeds were associated with hypertension, but large noncortical or cortical infarcts were not associated with BP or hypertension. After multivariable adjustment, BP and hypertension were not associated with neurocognitive function. Among patients with atrial fibrillation, BP is strongly associated with the presence and extent of white matter lesions, but there is no association with large noncortical or cortical infarcts. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02105844.

SUBMITTER: Aeschbacher S

PROVIDER: S-EPMC7803457 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Blood Pressure and Brain Lesions in Patients With Atrial Fibrillation.

Aeschbacher Stefanie S Blum Steffen S Meyre Pascal B PB Coslovsky Michael M Vischer Annina S AS Sinnecker Tim T Rodondi Nicolas N Beer Jürg H JH Moschovitis Giorgio G Moutzouri Elisavet E Hunkeler Christof C Burkard Thilo T Eken Ceylan C Roten Laurent L Zuern Christine S CS Sticherling Christian C Wuerfel Jens J Bonati Leo H LH Conen David D Osswald Stefan S Kühne Michael M

Hypertension (Dallas, Tex. : 1979) 20201228 2

The association of blood pressure (BP) and hypertension with the presence of different types of brain lesions in patients with atrial fibrillation is unclear. BP values were obtained in a multicenter cohort of patients with atrial fibrillation. Systolic and diastolic BP was categorized in predefined groups. All patients underwent brain magnetic resonance imaging and neurocognitive testing. Brain lesions were classified as large noncortical or cortical infarcts, small noncortical infarcts, microb ...[more]

PMID: 33356398

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Project description:BackgroundWhether elevated blood pressure (BP) is a modifiable risk factor for atrial fibrillation (AF) is not established. We tested (1) whether the association between BP and risk of AF is causal, (2) whether it varies according to individual's genetic susceptibility for AF, and (3) the extent to which specific BP-lowering drugs are expected to reduce this risk.MethodsFirst, causality of association was assessed through two-sample Mendelian randomization, using data from two independent genome-wide association studies that included a population of one million Europeans in total. Second, the UK Biobank data of 329,237 participants at baseline was used to study the effect of BP on AF according to genetic susceptibility of developing AF. Third, a possible treatment effect with major BP-lowering drug classes on AF risk was predicted through genetic variants in genes encode the therapeutic targets of each drug class. Estimated drug effects were compared with effects on incident coronary heart disease, for which direct trial evidence exists.ResultsThe two-sample Mendelian randomization analysis indicated that, on average, exposure to a higher systolic BP increased the risk of AF by 19% (odds ratio per each 10-mmHg [OR] 1.19 [1.12 to 1.27]). This association was replicated in the UK biobank using individual participant data. However, in a further genetic risk-stratified analysis, there was evidence for a linear gradient in the relative effects of systolic BP on AF; while there was no conclusive evidence of an effect in those with low genetic risk, a strong effect was observed among those with high genetic susceptibility for AF. The comparison of predicted treatment effects using genetic proxies for three main drug classes (angiotensin-converting enzyme inhibitors, beta-blockers, and calcium channel blockers) suggested similar average effects for the prevention of atrial fibrillation and coronary heart disease.ConclusionsThe effect of elevated BP on the risk of AF is likely to be causal, suggesting that BP-lowering treatment may be effective in AF prevention. However, average effects masked clinically important variations, with a more pronounced effect in individuals with high genetic susceptibility risk for AF.

Dataset Information

Blood Pressure and Brain Lesions in Patients With Atrial Fibrillation.

Publications

Blood Pressure and Brain Lesions in Patients With Atrial Fibrillation.

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