Aldosterone to Renin Ratio as a Screening Instrument for Primary Aldosteronism in a Middle-Aged Population with Atrial Fibrillation

AbstractAtrial fibrillation seems to be overrepresented among patients with primary aldosteronism. The aim of this study was to determine the usefulness of aldosterone to renin ratio as a screening instrument for primary aldosteronism in an atrial fibrillation population with relatively low cardiovascular risk profile. A total of 149 patients <65 years and with history of AF were screened for primary aldosteronism using aldosterone to renin ratio. Pathologically increased aldosterone to renin ratio (>65 pmol/mIU) was found in 15 participants (10.1%). Further investigation of the positive screened participants and confirmatory saline infusion test resulted in a diagnosis of primary aldosteronism in four individuals out of 149 (2.6%). Three out of the four individuals with primary aldosteronism had previously been diagnosed with hypertension, but only one out of the four had uncontrolled blood pressure, that is, >140/90 mmHg. All participants had normal potassium levels. Individuals with increased aldosterone to renin ratio had significantly higher mean systolic and diastolic blood pressure in comparison to participants with normal aldosterone to renin ratio (136 vs. 126 mmHg, p=0.02 and 84 vs. 78 mmHg, p=0.02). These findings suggest that assessment of aldosterone to renin ratio can be useful for identification of underlying primary aldosteronism in patients with diagnosed atrial fibrillation and hypertension in spite of well controlled blood pressure and normokalemia.

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Heart failure in low risk patients with atrial fibrillation, nationwide registry case-control study based on 227811 patients

European Heart Journal ◽

10.1093/eurheartj/ehab724.0843 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C Basic ◽

P Hansson ◽

T Zverkova-Sandstrom ◽

B Johansson ◽

M Fu ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Cardiovascular Risk ◽

Incidence Rate ◽

Prediction Models ◽

Risk Profile ◽

Cardiovascular Risk Profile ◽

One Year ◽

Low Cardiovascular Risk

Abstract Background Heart failure (HF) is common in patients with atrial fibrillation (AF), and also associated with worse outcome. Consequently, it is commonly included in risk prediction models for AF, used in daily clinical praxis. However, knowledge about the association between solely AF and incidental HF is limited. Aim This study aims to evaluate the short and long-term risks for onset of HF in patients with AF and low cardiovascular risk profile. Methods All patients with first recorded hospitalization for AF in the Swedish National Patient Register, were included from the 1St January 1987 to 31st December 2018. Each patient with AF was matched by age, sex and county with two controls from the Swedish Total Population Register. Patients <18 years, or with concomitant hypertension, diabetes mellitus, coronary and periphery artery disease, previous stroke or transitory ischemic attack, cardiomyopathy, pulmonary arterial hypertension, congenital heart disease, valvular heart disease and renal failure prior or at baseline were excluded. Results In total 227 811 patients and 452 712 controls met the inclusion and exclusion criteria and were included in the study. The incidence rate for incidental HF per 1000 person-year within one year after AF diagnosis was 6.2 (95% CI: 4.5–8.6) among patient 18–34, increased with increasing age and was 142.8 (95% CI: 139.4–146.3) among those >80 years. Within five years the incidence rate decreased in all age categories and was 2.4 (95% CI: 1.8–3.0) among the youngest and 94.0 (95% CI: 92.4–95.6) in the oldest age group. When compared to matched controls from the general population patients with AF had a hazard ratio (HR) and CI 95% to develop HF within one year at 103.9 (46.3–233.1), 34.9 (26.5–45.9), 17.5 (15.5–19.8), 10.3 (9.6–11.1) and 6.1 (5.8–6.4) among patients aged 18–34, 35–49, 50–59, 60–69, 70–79 and >80 years, respectively. Conclusion Despite low cardiovascular risk profile AF still carries high risk for developing incidental HF in particular during the first observation year with increasing tendency along with increasing age. Younger patients with AF and without other cardiovascular comorbidities had more than 100 times higher relative risk to develop HF within one year when compared to matched controls. FUNDunding Acknowledgement Type of funding sources: None.

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Determinants of attaining and maintaining a low cardiovascular risk profile—the Doetinchem Cohort Study

European Journal of Public Health ◽

10.1093/eurpub/ckv125 ◽

2015 ◽

Vol 26 (1) ◽

pp. 135-140 ◽

Cited By ~ 5

Author(s):

Gerben Hulsegge ◽

Yvonne T. van der Schouw ◽

Martha L. Daviglus ◽

Henriëtte A. Smit ◽

W.M. Monique Verschuren

Keyword(s):

Cohort Study ◽

Cardiovascular Risk ◽

Risk Profile ◽

Cardiovascular Risk Profile ◽

Low Cardiovascular Risk

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Impact of the COVID‑19 pandemic on blood pressure control and cardiovascular risk profile in patients with hypertension

Polish Archives of Internal Medicine ◽

10.20452/pamw.16129 ◽

2021 ◽

Vol 131 (10) ◽

Author(s):

Andrzej Januszewicz ◽

Wiktoria Wojciechowska ◽

Aleksander Prejbisz ◽

Piotr Dobrowolski ◽

Marek Rajzer ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Blood Pressure Control ◽

Pressure Control ◽

Risk Profile ◽

Cardiovascular Risk Profile

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Abstract P091: Reasons For Uncontrolled Blood Pressure Among US Adults

Circulation ◽

10.1161/circ.143.suppl_1.p091 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Swati Sakhuja ◽

Calvin Colvin ◽

Oluwasegun Akinyelure ◽

Shakia T Hardy ◽

Paul Muntner

Keyword(s):

Blood Pressure ◽

Antihypertensive Medication ◽

Self Report ◽

Medication Regimen ◽

Uncontrolled Blood Pressure ◽

Surgeon General ◽

Health And Nutrition ◽

Hypertension Awareness ◽

History Of ◽

Healthcare Visit

Introduction: In October 2020, the US Surgeon General issued a Call to Action on hypertension control. We investigated the contribution of lack of awareness, not taking antihypertensive medication and an inadequate antihypertensive medication regimen to uncontrolled blood pressure (BP) among US adults. Methods: We analyzed data for 2,282 participants ≥18 years of age with uncontrolled BP from the 2015-2016 and 2017-2018 National Health and Nutrition Examination Surveys (NHANES). BP was measured three times by a trained physician following a standardized protocol. Uncontrolled BP was defined by systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. Being aware of having hypertension and antihypertensive medication use were defined by self-report. An inadequate antihypertensive medication regimen was defined as taking antihypertensive medication with uncontrolled BP. Data were weighted to represent the non-institutionalized US population. Results: Among US adults with uncontrolled BP, 34.8% were not aware they had hypertension, 13.8% were aware but not taking antihypertensive medication and 51.4% were aware but taking inadequate antihypertensive medication regimen. US adults 18-39 and 40-49 years of age were more likely to be unaware they had hypertension compared to their counterparts ≥70 years of age (multivariable-adjusted prevalence ratios [PR]: 1.62 [95% CI: 1.26-2.07] and 1.41 [95% CI: 1.02-1.95], respectively). Participants who had a healthcare visit in the past year (PR: 0.60 [95% CI: 0.47-0.77]) and who were obese (PR: 0.69 [95% CI: 0.56-0.85]), had diabetes (PR: 0.56 [95% CI: 0.42-0.76]), chronic kidney disease (PR: 0.59 [95% CI: 0.46-0.75]) and a history of cardiovascular disease (PR: 0.41 [95% CI: 0.27-0.61]) were less likely to be unaware they had hypertension. Among those who were aware they had hypertension, US adults who were 18-39 and 40-49 years of age as compared to those ≥70 years of age were more likely to be not taking antihypertensive medication versus taking inadequate antihypertensive medication regimen (multivariable-adjusted PR: 5.48 [95% CI: 3.17-9.48] and 5.14 [95% CI: 2.28-10.26], respectively). In contrast, non-Hispanic blacks and Hispanics as compared to non-Hispanic whites (PR: 0.71 [95% CI: 0.53-0.94] and 0.72 [95% CI: 0.54-0.96], respectively) and those without a usual place to receive healthcare (PR: 0.70 [95% CI 0.51-0.96]) and who had a healthcare visit in past year (PR: 0.47 [95% CI: 0.35-0.62]) were less likely to be not taking antihypertensive medication versus taking inadequate antihypertensive medication regimen. Conclusion: The majority of US adults with uncontrolled BP were either unaware they had hypertension or were taking an inadequate antihypertensive medication regimen. Interventions are needed to increase hypertension awareness and assess and titrate patients’ antihypertensive medication regimen.

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6072Risk of stroke in hypertensive patients with atrial fibrillation treated with oral anticoagulants

European Heart Journal ◽

10.1093/eurheartj/ehz746.0121 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R E Harskamp ◽

W A M Lucassen ◽

R D Lopes ◽

H C Van Weert

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Vitamin K ◽

Major Bleeding ◽

Oral Anticoagulants ◽

Haemorrhagic Stroke ◽

Uncontrolled Hypertension ◽

P Value ◽

Systemic Embolism ◽

History Of

Abstract Background Hypertension is common in patients with atrial fibrillation (AF) and carries an additional risk for complications, most notably stroke and bleeding. We assessed the history of hypertension, level of blood pressure control, and an interaction with the choice of oral anticoagulants on clinical outcomes. Purpose To gain insights into the risks of hypertension in the setting of AF and explore possible interactions with the safety and efficacy of non-vitamin K oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs). Methods We performed a systematic review and meta-analysis of studies that randomised patients to NOACs or VKAs and reported outcomes stratified by presence of hypertension. Collected outcomes included: ischaemic stroke or systemic embolism (SE), death from any cause, hemorrhagic stroke, major bleeding, and intracranial hemorrhage. Log adjusted hazard ratios (HR) and corresponding standard error were calculated, and HRs were compared using Mantel-Haenszel random effects. Quality of the evidence was assessed with Cochrane risk of bias tool. Results Five high-quality studies were eligible, including 71,602 participants who received NOACs (apixaban, dabigatran, edoxaban, rivaroxaban) or VKAs, with median follow-up of 1.8–2.8 years. 89.2% of participants had a history of hypertension. Compared with patients without hypertension, those with controlled and uncontrolled hypertension had higher risk for stroke/SE (HR: 1.21 [1.04–1.41] and HR: 1.50 [1.12–2.01], respectively) and haemorrhagic stroke (HR: 1.78 [1.06, 3.00] and HR: 1.66 [0.99–4.01], respectively). On a continuous scale, the risk of stroke increased 7% per 10mmHg increase in systolic blood pressure. As shown in the Table, no interactions were found between hypertension status and the efficacy or safety of NOACs versus VKAs. Table 1. Interaction of presence of hypertension on the comparative efficacy and safety of NOAC versus VKA Hypertension (n=63,869) No hypertension (n=7,733) P-value (int) Adjusted HR, 95% CI Adjusted HR, 95% CI Stroke or systemic embolism 080, 0.72–0.89 0.79, 0.53–1.19 0.98 Haemorrhagic stroke 0.55, 0.41–0.74 0.24, 0.04–1.37 0.36 Death from any cause 0.91, 0.84–0.98 0.89, 0.76–1.04 0.82 Major bleeding 0.90, 0.76–1.07 0.84, 0.69–1.01 0.57 Intracranial haemorrhage 0.41, 0.24-.068 0.48, 0.14–1.69 0.81 Major or clinically relevant non-major bleed 0.90, 0.68–1.18 0.91, 0.55–1.53 0.96 Conclusions Adequate blood pressure management is vital to optimally reduce the risk of stroke in patients with atrial fibrillation. The benefits of NOACs over VKAs, also apply to patients with elevated blood pressure.

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P877Comparing the MINOCA and MIOCA patients risk profile and prognosis according to definitions of 2016 ESC position paper

European Heart Journal ◽

10.1093/eurheartj/ehz747.0474 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R J Cobas Paz ◽

E Abu-Assi ◽

S Raposeiras Roubin ◽

B Caneiro Queija ◽

M Cespon Fernandez ◽

...

Keyword(s):

Atrial Fibrillation ◽

Composite Endpoint ◽

Risk Profile ◽

Position Paper ◽

Coronary Vessel ◽

Prognostic Impact ◽

Vessel Disease ◽

History Of ◽

Artery Disease ◽

History Of Depression

Abstract Introduction MINOCA (myocardial infarction with non-obstructive coronary arteries) has been recently redefined by the last ESC guidelines. The aim of this study is to analyze clinical profile and long-term prognosis of these patients. Methods Retrospectively, between 1/2010 and 12/2016 all consecutive patients with the definitive diagnosis of MI in tertiary center were included in this observational study. Patients with unstable angina with non-obstructive coronary artery disease and those who died in-hospital were excluded. Patients were stratified according to the number of significant coronary vessel disease seen by coronary angiography into: 0 (MINOCA); 1; 2; ≥3 vessels. The definition of MINOCA was based on dedicated the 2016 ESC Working Group position paper. Patients with MINOCA were compared to their counterpounds (MIOCA; MI with obstructive CAD) regarding baseline clinical characteristics, on-admission and laboratory data and treatment at hospital discharge. The prognostic meaning of MINOCA vs MIOCA was ascertained by comparing the composite endpoint (re-ACS, stroke and death) rate among groups, using Kaplan-Meier and multivariate Cox regression analyses. Results 13.8% (n=597) pts were classified as MINOCA. They were older and more frequently women than the obstructive group. MINOCA group also had a worse cardiovascular risk profile than pts with obstructive coronary lesions. They were associated more frequently with atrial fibrillation during hospitalization (11.2% vs. 6.8%, p<0.01). Peak of troponin I was lower in the MINOCA group [median 12 (IQR: 1.4–42.0 vs 20 (2.3–95.5), p<0.01]. MINOCA pts had more frequently a previous history of depression (34.1% vs 19.3%, p<0.01), and malignancy (9.2% vs. 7.6%, p=0.18). During 15 months (IQR: 12,3–25,5), 613 (14.2) pts had a new ACS, stroke or died (251 pts developed a new ACS, 81 had stroke, and 281 died). The incidence of the composite endpoint was 4.2% in the MINOCA pts, 4.1% in pts with 1-significant coronary vessel disease, 6.3% in the 2-significant coronary vessel disease, and 9.5% in the ≥3-significant coronary vessel disease (p<0.01) (Figure). After adjusting for age, ACS type, sex, Killip class, age, HTA, DM, stroke, peripheral artery disease, smoking, prior CAD, COPD, prior malignancy, baseline hemoglobin and creatinine values, DES vs BMS, history of atrial fibrillation, and treatment at discharge, and considering MINOCA as a reference group, HR for the composite endpoint was 1.02 (0.60–1.78; p=0.93) for the 1-vessel group, 1.3 (0.7–2.2; p=0.41) for the 2-vessels group, and 1.6 (0.93–2.8; p=0.08) for the ≥3-vessels group. Figure 1. Composite endpoint Conclusions In the present cohort MINOCA was approximately found in one of each 14 patients admitted with MI. These patients had worse CV risk profile and more history of depression. MINOCA pts have similar prognostic impact in terms of hospitalization for a new ACS, stroke and death than the obstructive group.

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