Circ Arrhythm Electrophysiol：左室肥厚的高血压患者新发房颤增加SCD风险

高血压和左室肥厚患者增加房颤发生风险。而房颤可增加普通人群和心梗患者的死亡风险，但在心衰患者这一人群研究结果与此并不一致。众所周知，伴有左室肥厚的高血压患者SCD风险增加。是否高血压患者出现新发房颤独立于其他AF和SCD危险因素从而增加SCD风险目前并不清楚。美国康乃尔大学Weill医学院的Peter M. Okin等研究人员对此进行了初步研究，研究结果发表2013年4月的Circulation：Arrhythmia Electrophysiol杂志上。

研究纳入8831例心电图结果为左室肥厚的高血压患者，既往无房颤病史，基线心电图为窦性心律。研究对象随机分配至氯沙坦或阿替洛尔治疗组。经过平均4.7±1.1年随访，总共有701例（7.9%）患者出现新发房颤，出现SCD患者有151例（1.7%）。单变量Cox分析显示，新发房颤可致SCD风险增加四倍以上（危险比=4.69,95%CI 2.96-7.45；P<0.001）。在多变量Cox分析中，经年龄、性别、种族、糖尿病、心衰病史、心肌梗死、缺血性心脏病、卒中、吸烟、高密度脂蛋白胆固醇、肌酐、血糖、尿白蛋白/肌酐比等标准的危险因素校正，心肌梗死事件、地高辛治疗、收缩压和舒张压、心率、QRS宽度、Cornell voltage-duration product或Sokolow-Lyon voltage标准诊断的左心室肥厚作为时变协变量，其结果显示新发房颤可增加3倍以上SCD风险（HR=3.13; 95%CI, 1.87–5.24; P<0.001）。

综上分析研究人员最后指出，高血压患者的新发房颤意味着SCD风险增加。

该研究表明高血压患者出现新发房颤需进一步评估并进行危险分层以更好的进行SCD预防治疗。同时也表明高血压患者房颤预防治疗可作为减少SCD风险一治疗方案。当然这需要进一步的研究来确定是否减少房颤发生可减少高血压患者SCD风险。

与高血压相关的拓展阅读：

• Diabetic Med：高血压患者治疗时HDL低预示新发糖尿病风险更高
• 高血压的控制：争鸣仍未息
• EHJ：ESC支持肾脏去神经化能用于难治性高血压治疗
• BMJ：高钾摄入降低高血压患者的血压
• JAMA Neurol:高血压协同致AD病理蛋白沉积
• Hypertension：靶向交感神经消融可降低遗传盐敏感性高血压 更多信息请点击：有关高血压更多资讯

Relationship of sudden cardiac death to new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy.
Abstract
Background- Prevalent atrial fibrillation (AF) is associated with a higher sudden cardiac death (SCD) rate in some populations, and incident AF predicts increased mortality risk in the general population and after myocardial infarction. However, the relationship of SCD to new-onset AF is unclear. Methods and Results- The relationship of SCD to new-onset AF was evaluated in 8831 hypertensive patients with electrocardiographic left ventricular hypertrophy with no history of AF, in sinus rhythm on their baseline electrocardiogram, randomly assigned to losartan- or atenolol-based treatment. During 4.7±1.1 years mean follow-up, new-onset AF occurred in 701 patients (7.9%) and SCD in 151 patients (1.7%). In univariate Cox analyses, new-onset AF was associated with a >4-fold higher risk of SCD (hazard ratio, 4.69; 95% CI interval, 2.96-7.45; P<0.001). In multivariate Cox analyses adjusting for age, sex, race, diabetes mellitus, history of heart failure, myocardial infarction, ischemic heart disease, stroke, smoking, serum high-density lipoprotein cholesterol, creatinine, glucose, and urine albumin/creatinine ratio as standard risk factors, and for incident myocardial infarction, in-treatment use of digoxin, systolic and diastolic pressure, heart rate, QRS duration, Cornell voltage-duration product, and Sokolow-Lyon voltage left ventricular hypertrophy treated as time-varying covariates, new-onset AF remained associated with a >3-fold increased risk of SCD (hazard ratio, 3.13; 95% confidence interval, 1.87-5.24; P<0.001). Conclusions- Development of new-onset AF identifies hypertensive patients at increased risk of SCD. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00338260.