483Blood pressure and white matter lesions in patients with atrial fibrillation

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: Aeschbacher, S, Blum, S, Meyer-Zurn, C, Vischer, A S, Meyre, P, Rodondi, N, Beer, J H, Moschovitis, G, Moutzouri, E, Sticherling, C M, Wurfel, J, Bonati, L H, Osswald, S, Conen, D, Kuhne, M
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-10-2019
• Subjects: Arrhythmias, General - Epidemiology, Prognosis, Outcome
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz747.0133

Abstract
Background
Hypertension (HTN) is one of the most common cardiovascular risk factors in patients with atrial fibrillation (AF). As a potential risk factor for cerebral white matter lesions (WML), HTN might explain the increased risk of cognitive dysfunction in AF patients.
Methods
In a multicenter cohort study of patients with documented AF in Switzerland, systolic and diastolic blood pressure (SBP, DBP) was measured up to three times in a supine position and the mean was calculated. HTN was defined as controlled, when SBP was <140 and DBP <90 mmHg with treatment, and uncontrolled when SBP was ≥140 or DBP ≥90 mmHg with treatment. All patients underwent brain magnetic resonance imaging. Volumes of WML were assessed and graded using the Fazekas scale. A Fazekas score of ≥2 was defined as moderate or severe WML. Multivariable adjusted regression models were used to assess the association between BP and WML.
Results
Overall, 1738 patients were enrolled in this cross-sectional analysis (mean age 73 years, 73% males). Mean BP was 135/79 mmHg, 69% had a history of HTN. Any WMLs were found in 99% of the patients and 54% had at least moderate WMLs. The prevalence of Fazekas ≥2 was 47%, 50% and 61% among AF patients with SBP <120, 120–140 and ≥140mmHg (p<0.001), respectively. Volumes of WMLs significantly increased across the same SBP categories (2943, 3512 and 4988 mm3, p<0.001). Among patients with normotension, controlled and uncontrolled HTN, moderate or severe WMLs were present in 173 (42.5%), 345 (55%) and 307 (61%), respectively. SBP was associated with Fazekas ≥2 and WML volume after multivariable adjustment (Table). Compared to normotension, both controlled and uncontrolled HTN were significantly associated with higher WML volume (Table).
Association between blood pressure and white matter lesions
Blood pressure
Fazekas ≥2 OR (95% CI)
Volume WML β-coefficient (95% CI)
<120 mmHg
Ref
Ref
120–140 mmHg
1.17 (0.88; 1.55)
0.14 (−0.01; 0.30)
≥140 mmHg
1.49 (1.11; 2.00)
0.28 (0.12; 0.43)
Continuous, per SD
1.20 (1.09; 1.36), p<0.001
0.12 (0.06; 0.18), p<0.001
Normotension
Ref
Ref
Treated hypertension
1.26 (0.94; 1.68), p=0.12
0.22 (0.07; 0.38), p=0.005
Treated, uncontrolled hypertension
1.52 (1.13; 2.05), p=0.005
0.38 (0.21; 0.54), p<0.001
Regression analyses were adjusted for age, sex, BMI, smoking status, stroke, diabetes, coronary heart disease, AF type, and antihypertensive treatment. One standard Deviation (SD) of SBP = 18 mmHg. Volume of WML was log-transformed.
Conclusion
Moderate or severe cerebral WMLs are highly prevalent in AF patients and strongly associated with SBP. Our data suggests that optimal treatment of HTN might play an essential role in preventing WMLs.
Acknowledgement/Funding
Swiss National Science Foundation