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

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] 130–139mmHg; diastolic blood pressure [DBP] 80–89mmHg); 2 for stage 2 (SBP 140–159mmHg and DBP 90–99mmHg); and 3 for stage 3 (SBP ≥ 160mmHg or DBP ≥ 100mmHg). 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 ± 1.7years, 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.