Atrial fibrillation ups risk of cardiovascular disease, mortality in older hypertensive adults

In older adults with hypertension, the presence of atrial fibrillation may increase the risk of mortality, stroke, heart failure, fatal and nonfatal cardiovascular events, suggests a study.

The randomized, placebo-controlled Hypertension in the Very Elderly Trial assessed the prognostic value of electrocardiographic atrial fibrillation in older people with hypertension. A total of 3,845 hypertensive individuals aged ≥80 years were included, among whom 3,273 had electrographic data on the presence or absence of atrial fibrillation at baseline and without established cardiovascular disease.

The investigators estimated the hazard ratios (HRs) with 95 percent confidence intervals (CIs) for all-cause mortality, incident fatal and nonfatal major cardiovascular events, all-stroke and all-heart failure using multivariate Cox proportional hazard models. Mean follow-up time was 2.1 years.

Atrial fibrillation had a prevalence of 5.8 percent at baseline. After adjustments, older hypertensive adults with atrial fibrillation at baseline had a higher risk of mortality (HR, 2.49, 95 percent CI, 1.80–3.44; p<0.001), nonfatal and fatal cardiovascular events (HR, 2.47, 95 percent CI, 1.71–3.55; p<0.001), all-stroke (HR, 2.47, 95 percent CI, 1.34–4.56; p=0.004) and all-heart failure (HR, 2.33, 95 percent CI, 1.10–4.93; p=0.027) compared with those without.

“Atrial fibrillation is an important risk factor to consider when assessing older hypertensive adults as it is associated with increased risk of mortality, nonfatal and fatal cardiovascular events, stroke, and heart failure,” the investigators said.