Restoring sinus rhythm results in blood pressure reduction in patients with persistent atrial fibrillation and a history of hypertension

Effects of Rhythm Control on Blood Pressure . Introduction: The long‐term effects of atrial fibrillation (AF) on blood pressure (BP) in patients with hypertension (HTN) remain unclear. We hypothesized that restoration of normal sinus rhythm (NSR) results in a decrease in BP despite the expected increase in cardiac output. Methods and Results: Twenty‐four‐hour BP measurements were obtained during AF, and on Day 1 and Day 30 post‐successful cardioversion in 18 patients with AF and HTN (cardioversion group), and another 22 patients with AF and HTN with no immediate plans for cardioversion (control group). Except for the duration of AF, the clinical characteristics and use of medications were similar between the groups. In the cardioversion group, a significant decrease in diastolic blood pressure (DBP) and mean blood pressure (MBP) were noted on Day 1 post‐cardioversion with no significant change in systolic blood pressure (SBP): 117/74/88 ± 13/9/9 mmHg during AF and 116/70/85 ± 13/9/10 mmHg during Day 1 post‐cardioversion (P = 0.68; <0.01 and 0.04 for SBP, DBP, and MBP, respectively). In the 13 subjects who remained in NSR at Day 30, DBP and MBP decreased further on Day 30 when compared to Day 1 with no significant change in SBP: 118/76/90 ± 13/7/8 mmHg during AF; 119/72/88 ± 12/8/9 mmHg during Day 1; and 118/69/86 ± 10/8/7 mmHg during Day 30 post‐cardioversion (P = 0.97; <0.001 and 0.03 for SBP, DBP, and MBP, respectively). In the control group, no significant changes in BP were noted. Conclusion: Restoring NSR in patients with AF and HTN resulted in a sustained decrease in DBP and MBP. To our knowledge, this is the first study to show that maintenance of NSR improves BP control in patients with AF and HTN. (J Cardiovasc Electrophysiol, Vol. 23, pp. 722‐726, July 2012)     

AFFIRM and RACE Trials: Implications for the Management of Atrial Fibrillation

The Atrial Fibrillation (AF) Follow-up Investigation of Rhythm Management (AFFIRM) and Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study (RACE) Trials evaluated strategies of rate control or rhythm control in atrial fibrillation. AFFIRM enrolled patients with recent onset AF, and at entry over half of all patients were in sinus rhythm. At any point in the trial, the achieved difference in cardiac rhythm was likely only about 30%. In RACE all patients were entered in AF, and at the end of the study, sinus rhythm was present in 10% vs 39%. The strategy of rate control was non-inferior to the rhythm control strategy in both trials, and permits consideration of rate control as primary therapy. However, the actual differences in rhythm were relatively small, and do not allow the conclusion that maintenance of sinus rhythm is inferior to non-maintenance.Current guidelines recommend that patients with paroxysmal AF receive warfarin if they have risk factors for stroke. This is supported by data from AFFIRM. Most strokes in AFFIRM occurred either during subtherapeutic INR, or after cessation of warfarin. Since more patients in the rhythm control arm of AFFIRM discontinued warfarin, it is possible that asymptomatic recurrences of paroxysmal AF fostered clot development and embolization. We cannot answer from the data available whether or not it is safe to discontinue anticoagulation if all episodes of AF are suppressed.Among the reasons that AF is associated with increased mortality may be that it encourages development of congestive heart failure or progressive left ventricular dysfunction. Congestive heart failure occurrence was monitored in both trials, and occurred at a rate of 2-5% without significant differences between rate and rhythm arms. In patients with heart failure at entry, a mortality trend in AFFIRM favored the rhythm control arm. The issue of survivorship and rhythm control in AF in congestive heart failure is undergoing further testing.     

When,how, and why should sinus Rhythm be restored in patients with persistent atrial fibrillation?

Opinion statement The results of the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial indicate that the rate control strategy is preferred for the majority of patients with paroxysmal and persistent atrial fibrillation (AF). If the patient remains symptomatic despite adequate rate control or if rate control cannot be achieved, then rhythm control therapies are indicated. The most likely explanation for the disappointing results of the AFFIRM trial is the poor efficacy and excessive toxicity of rhythm control medications, because the presence of sinus rhythm was associated with a favorable prognosis in AFFIRM. As a result, there is currently great interest in nonpharmacologic therapies such as AF ablation and development of new drugs for AF with a more favorable efficacy and toxicity profile. AF ablation should be reserved for patients who fail an initial trial of a rhythm control medication until additional clinical trial information is available to justify the use of AF ablation as first-line therapy. When rhythm control therapy is indicated, the choice of antiarrhythmic medication should be dictated by the presence or absence of structural heart disease, congestive heart failure, renal dysfunction, or other comorbidities in order to maximize efficacy and minimize the chance of proarrhythmia or extracardiac toxicity.     

Registry of the Egyptian specialized hypertension clinics: Sex‐related differences in clinical characteristics and hypertension management among low socioeconomic hypertensive patients

Hypertension is a major modifiable risk factor for cardiovascular disease (CVD) which is a leading cause of death in developing countries affecting both genders. Gender dissimilarity in clinical characteristics and hypertension (HTN) management among hypertensive patients has been reported in several reports before. The aim was to detect sex differences in clinical characteristics and HTN management among Egyptian hypertensive patients. Data from 4701 hypertensive patients attending 9 university located Specialized Hypertension clinic (SHC) were collected from October 2014 to September 2017. The collected data included demographics, cardiovascular risk profile, hypertension‐related history, anthropometric and blood pressure (BP) measurements, antihypertensive medications used, number of patients attending the follow‐up visits, and HTN control rate. Females represented 58.5% of the recruited patients, they were younger, with higher BMI, lower education level, and employment rate compared with males. Females had lower mean office systolic and diastolic BP than males (144.2 ± 22.6 vs. 146.5 ± 22.0 mmHg and 88.1 ± 13.0 vs. 89.9 ± 12.6 mmHg, respectively) and lower rate of uncontrolled BP (54.8% vs. 61.1% in males P < .001). Antihypertensive drugs were comparable among both sexes except for angiotensin converting enzyme inhibitors which were more prescribed in males. Compliance to antihypertensive medications was better in females (63.6% vs. 60.1% in males, P = .015). To conclude, Egyptian hypertensive females have different clinical characteristics as compared to their counterpart males with better BP control, adherence to antihypertensive medications, lower systolic and diastolic BP, and no major differences in the prescribed antihypertensive distribution.     

Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients

There are concerns that specific risk factors may alter the benefits of thrombolysis in stroke patients with controlled contraindications including hypertension. The objective of this study was to evaluate the association between clinical risk factors and outcomes in ischemic stroke patients that received thrombolysis therapy pretreated with antihypertensive medications. Using data obtained from a stroke registry, a non‐randomized retrospective data analysis was conducted on patients with the primary diagnosis of acute ischemic stroke with hypertension pretreated with antihypertensive medications. The association between clinical risk factors and functional ambulatory outcome was determined using logistic regression while odd ratios (OR) were used to predict the odds of achieving improved ambulatory outcome in thrombolysis treatment status. Improved or poor functional ambulatory outcome was considered as the end point in our analysis. A total of 4665 acute ischemic stroke patients were identified, of whom 1446 (31.0%) were eligible for thrombolysis, while 3219 were not, and 595 received rtPA, of whom 288 were on antihypertensive medications, while 233 were not. In the rtPA group with antihypertensive (anti‐HTN) medication, only NIHSS score (OR = 1.094, 95% CI, 1.094‐1.000, P = 0.005) was associated with improved functional outcome while patients with congestive heart failure (OR = 0.385, 95% CI, 0.385‐0.159, P = 0.035) and patients with a history of previous TIA (OR = 0.302, 95% CI, 0.302‐0.113, P = 0.017) were more likely to be associated with poor functional outcomes. Congestive heart failure and TIA are independent predictors of functional outcomes in stroke patients pretreated with antihypertensive medications prior to thrombolysis therapy.     

A senior center-based pilot trial of the effect of lifestyle intervention on blood pressure in minority elderly people with hypertension

OBJECTIVES: To test the feasibility, acceptability, and effect of a senior center–based behavioral counseling lifestyle intervention on systolic blood pressure (BP). DESIGN: A pre‐post design pilot trial of behavioral counseling for therapeutic lifestyle changes in minority elderly people with hypertension. Participants completed baseline visit, Visit 1 (approximately 6 weeks postbaseline), and a final study Visit 2 (approximately 14 weeks postbaseline) within 4 months. SETTING: The study took place in six community‐based senior centers in New York City with 65 seniors (mean age 72.29±6.92; 53.8% female; 84.6% African American). PARTICIPANTS: Sixty‐five minority elderly people. INTERVENTION: Six weekly and two monthly “booster” group sessions on lifestyle changes to improve BP (e.g., diet, exercise, adherence to prescribed antihypertensive medications). MEASUREMENTS: Primary outcome was systolic BP (SBP) measured using an automated BP monitor. Secondary outcomes were diastolic BP (DBP), physical activity, diet, and adherence to prescribed antihypertensive medications. RESULTS: There was a significant reduction in average SBP of 13.0±21.1 mmHg for the intervention group (t(25)=3.14, P=.004) and a nonsignificant reduction in mean SBP of 10.6±30.0 mmHg for the waitlist control group (t(29)=1.95, P=.06). For the intervention group, adherence improved 26% (t(23)=2.31, P=.03), and vegetable intake improved 23% (t(25)=2.29, P=.03). CONCLUSION: This senior center–based lifestyle intervention was associated with a significant reduction in SBP and adherence to prescribed antihypertensive medications and diet in the intervention group. Participant retention and group attendance rates suggest that implementing a group‐counseling intervention in senior centers is feasible.     

Effect of concomitant Renal DeNervation and cardiac ablation on Atrial Fibrillation recurrence – RDN+AF study

Background

Renal denervation (RDN) can reduce cardiac sympathetic activity maintained by arterial hypertension (aHT). Its potential antiarrhythmic effect on rhythm outcome in patients with multi-drug resistant aHT undergoing catheter ablation for atrial fibrillation (AF) is unclear.

Methods

The RDN+AF study was a prospective, randomized, two-center trial. Patients with paroxysmal or persistent AF and uncontrolled aHT (mean systolic 24-h ambulatory BP > 135 mmHg) despite taking at least three antihypertensive drugs were enrolled. Patients were 1:2 randomized to either RDN+AF ablation or AF-only ablation. Primary endpoint was freedom from any AF episode > 2 min at 12 months assessed by implantable loop recorder (ILR) or 7d-holter electrocardiogram. Secondary endpoints included rhythm outcome at 24 months, blood pressure control, periprocedural complications, and renovascular safety.

Results

The study randomized 61 patients (mean age 65 ± 9 years, 53% men). At 12 months, RDN+AF patients tended to have a greater decrease in ambulatory BPs but did not reach statistical significance. No differences in rhythm outcome were observed. Freedom from AF recurrence in the RDN+AF and AF-only group measured 61% versus 53% p = .622 at 12 months and 39% versus 47% p = .927 at 24 months, respectively. Periprocedural complications occurred in 9/61 patients (15%). No patient died.

Conclusion

Among patients with multidrug-resistant aHT and paroxysmal or persistent AF, concomitant RDN+AF ablation was not associated with better blood pressure control or rhythm outcome in comparison to AF-only ablation and medical therapy.     

Direct assessment of adherence and drug interactions in patients with hypertensive crisis—A cross‐sectional study in the Emergency Department

Though drug adherence is supposed to be low in hypertensive crisis (HTN‐C), there are no data available from direct adherence assessments. The aim of the present study was to evaluate adherence to prescribed antihypertensives and potential interactions of concomitant drugs and foods with prescribed antihypertensives in patients with HTN‐C by a direct evaluation via biochemical urine analysis. In the present cross‐sectional study, 100 patients with HTN‐C, admitted to the emergency department (ED), were included. A biochemical urine analysis using gas chromatography‐tandem mass spectrometry was performed. Out of 100 patients, 86 received antihypertensives. Urine analyses could be evaluated unambiguously in 62 patients. In 15 of these 62 patients (24%), a nonadherence could be demonstrated, and in 21 patients (34%), a partial nonadherence could be demonstrated. Patients with nonadherence or partial nonadherence showed a longer hypertension history (15[5‐22] vs 10[3‐15] years, P = 0.04) were prescribed more general medication (number 7.1 ± 3.4 vs 3.4 ± 1.8; P < 0.01) as well as antihypertensive drugs (number 2.8 ± 1.1 vs 1.5 ± 0.7, P < 0.01). A potential BP‐raising trigger by medications or food interaction was frequently detectable, predominantly with nonsteroidal anti‐inflammatory drugs (NSAIDs; n = 38), glucocorticoids (n = 8), antidepressants (n = 10), and licorice (n = 10). Nonadherence and partial nonadherence to prescribed antihypertensives might play a crucial role for the occurrence of HTN‐C. However, further case‐controlled studies are needed to confirm the present findings. Ingestion of concurrent over‐the‐counter drugs such as NSAIDs but also prescribed drugs as well as aliments may lead to critical BP elevation. In order to prevent HTN‐C, the present findings emphasize the importance for clinicians to pay attention to the issue of adherence and co‐medication.     

Comparison of rate versus rhythm control for atrial fibrillation in patients with left ventricular dysfunction (from the AFFIRM Study)

Optimal treatment for patients with atrial fibrillation (AF) and left ventricular (LV) dysfunction is not well defined. It is unclear if sinus rhythm is of greater benefit in patients with significantly reduced ejection fraction (EF) than in patients with normal or mildly depressed LV function. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study compared 2 treatment strategies: "rhythm control," attempting to maintain sinus rhythm, principally with antiarrhythmic drugs, and "rate control," allowing AF to persist or recur while controlling the ventricular rate. We sought to determine if rhythm control was superior to rate control for patients in the AFFIRM study with various degrees of LV dysfunction. The present study analyzed outcome data of 3,032 subjects from the AFFIRM study with LV dysfunction by 3 EF strata: 40% to 49%, 30% to 39%, and <30%. The end points were mortality, hospitalization, and a change in New York Heart Association (NYHA) class. Analyses were done by intent to treat and by final rhythm status. In conclusion, there was no significant improvement in mortality, hospitalization, and NYHA class with the strategy of rhythm control in any of the 3 EF strata. When the data were analyzed by final rhythm status, we again found no significant benefit to patients in the rhythm control arm.     

Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies.

AIMS: The AFFIRM and RACE studies showed that rate control is an acceptable treatment strategy for atrial fibrillation (AF). We examined whether strict rate control offers benefit over more lenient rate control. METHODS AND RESULTS: We compared the outcome of patients enrolled in the rate-control arms of AFFIRM and RACE, using data from patients who met a composite of overlapping inclusion and exclusion criteria. We evaluated 1091 patients, 874 from AFFIRM and 217 from RACE. In AFFIRM, the rate-control strategy aimed for a resting heart rate < or =80 bpm and heart rate during daily activity of < or =110 bpm. In RACE, a more lenient approach was taken: resting heart rate <100 bpm. Primary endpoint was a composite of mortality, cardiovascular hospitalization, and myocardial infarction. Mean heart rate across all follow-up visits for patients in AF was lower in AFFIRM (76.1 vs. 83.4 bpm). Event-free survival for the occurrence of the primary endpoint did not differ (64% in AFFIRM vs. 66% in RACE). Patients with mean heart rates during AF within the AFFIRM (< or =80) or RACE (<100) criteria had a better outcome than patients with heart rates > or =100 (hazard ratios 0.69 and 0.58, respectively, for < or =80 and <100 compared with > or =100 bpm). CONCLUSION: Stringency of the approach to rate control, based on the comparison of the AFFIRM and RACE studies, was not associated with an important difference in clinical events.     

Occurrence and characteristics of stroke events in the Atrial Fibrillation Follow-up Investigation of Sinus Rhythm Management (AFFIRM) study

BACKGROUND: Atrial fibrillation (AF) is a risk factor for stroke, especially when accompanied by other high-risk cardiovascular predictors. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study was a multicenter comparison of high-risk patients with AF who were randomized to either a sinus rhythm control or a rate control strategy. METHODS: Physicians were encouraged to continue anticoagulation therapy for their patients. Patients in the sinus rhythm control group could stop warfarin sodium therapy after 4 (preferably a minimum of 12) weeks if they maintained sinus rhythm while receiving an antiarrhythmic drug. RESULTS: The AFFIRM Study enrolled 4060 patients. Mortality was the same in both groups. Two hundred eleven patients (8.2%) had a stroke event. Ischemic stroke occurred in 157 patients (6.3%), primary intraparenchymal hemorrhage in 34 (1.2%), and subdural or subarachnoid hemorrhage in 24 (0.8%). The most frequently determined ischemic stroke mechanism was cardioembolic (35/71 [49%]). Treatment assignment had no significant effect on the occurrence of ischemic stroke. Patients in AF at the time of the stroke event had a 60% greater chance of having an ischemic stroke, and those taking warfarin at the time of follow-up had a 69% decrease in the risk of having an ischemic stroke. CONCLUSIONS: In the AFFIRM Study, stroke rates were not significantly different in the rate control and sinus rhythm control arms. However, several clinical and therapeutic variables were associated with stroke risk. In patients with a history of AF at high risk for stroke or death, the presence of AF increases the risk of having a stroke, and warfarin therapy reduces the risk of having a stroke. The beneficial effect of warfarin therapy is seen not only in patients in AF but also in patients with a history of AF but who presumably remain in sinus rhythm.     

Aortic blood pressure and arterial stiffness in patients with controlled resistant and non‐resistant hypertension

The purpose of the current study was to determine whether aortic blood pressure (BP) and arterial stiffness are greater in patients with controlled resistant hypertension (RHTN) than controlled non‐resistant hypertension (non‐RHTN) despite similar clinic BP level. Participants were recruited from University of Alabama at Birmingham (UAB) Hypertension Clinic. Controlled hypertension was defined as automated office BP measurement with BP < 135/85 mm Hg. A total of 141 participants were evaluated by pulse wave analysis (PWA) and carotid‐femoral pulse wave velocity (cf‐PWV). Among them, 75 patients had controlled RHTN with use of 4 or more antihypertensive medications and 56 patients had controlled non‐RHTN with use of 3 or less antihypertensive medications. Compared to patients with controlled non‐RHTN, those with controlled RHTN were more likely to be African American and had a higher prevalence of diabetes mellitus and congestive heart failure. The mean number of antihypertensive medications was greater in patients with controlled RHTN (4.4 ± 0.8 vs 2.3 ± 0.7, P < .001). Clinic brachial BP, aortic BP, augmentation pressure (AP), augmentation index normalized for heart rate of 75 beats per minute (AIx@75) and cf‐PWV were similar in both groups. In summary, there was no significant difference in central BP or arterial stiffness between patients with controlled RHTN and controlled non‐RHTN. These findings suggest that the higher residual cardiovascular risk observed in patients with RHTN after achieving BP control compared to patients with more easily controlled hypertension is not likely attributable to persistent differences in central BP and arterial stiffness.     

Survey of Emergency Physician Approaches to Management of Asymptomatic Hypertension

Uncontrolled hypertension (HTN) is commonly encountered in emergency medicine practice, but the optimal approach to management has not been delineated. The objective of this study was to define emergency physician (EP) approaches to management of asymptomatic HTN in various clinical scenarios and assess adherence to the American College of Emergency Physician clinical policies, utilizing an online survey of EPs. A total of 1200 surveys were distributed by e‐mail with completion by 199 participants. The variables associated with a decision to prescribe oral antihypertensive medications were a history of HTN and referral from primary care. Acute blood pressure (BP) reduction using intravenous antihypertensive medications was also more likely with the latter and BP >180/120 mm Hg. Logistic regression revealed association of EP female sex, fewer years in practice, and a high‐volume practice setting with guideline‐concordant therapy. Wide variability exists in EP approaches to patients with asymptomatic HTN. Treatment decisions were impacted by patient history of chronic HTN, referral from primary care providers, and magnitude of BP elevation.     

Significant reduction in systolic blood pressure following renal artery stenting in patients with uncontrolled hypertension: Results from the HERCULES trial

Background : Atherosclerotic renal artery stenosis (ARAS) causes hypertension (HTN) and threatens renal function (RF). The HERCULES Trial is a prospective, multicenter trial of renal stenting in patients with uncontrolled HTN and ARAS evaluating the safety and effectiveness of the RX Herculink Elite Renal Stent System (Abbott Vascular, Santa Clara, CA). Results : Mean systolic blood pressure (SBP) at baseline was 162 mm Hg. Nearly 70% of patients were receiving three or more antihypertensive medications (mean 3.4 medications per patient). Baseline serum creatinine was 1.2 ± 0.4 and 61.5% of subjects had estimated glomerular filtration <60. The restenosis rate was 10.5% at 9 months. The study device, procedure, and clinical success rates were 96.0, 99.2, and 98.0%, respectively. Freedom from major adverse events was 94.8%. At 9 months, the mean SBP significantly decreased (mean 145, paired t test P < 0.0001) after stenting with no change in medications. There was no correlation between SBP reduction and baseline BNP or BNP reduction. 相似文献   

ABO blood group is a risk factor for coronary artery disease in patients with poor blood pressure control

Background: Few studies had examined the role of ABO blood groups on CAD in hypertensive patients with different blood pressure (BP) controls. Methods: A total of 2708 patients with primary hypertension (HTN) were consecutively enrolled and underwent coronary angiography (CAG) due to angina-like chest pain. The severity of coronary artery stenosis was assessed by Gensini score (GS). Patients were divided into two groups due to results of CAG: HTN with CAD (n = 2185) and HTN without CAD (n = 523). Poor BP control was defined as systolic BP (SBP) ≥ mean in the study. Multivariable regression analysis was used to determine the potential impact of ABO blood groups on risk of the presence and severity of CAD. Results: Compared to HTN without CAD group, the percentage of A blood group was statistically higher and O blood group was significantly lower in HTN with CAD group. Moreover, percentage of the angiography-proven CAD was higher in A blood group than that in non-A blood group (p < 0.05). After adjusting for confounding factors, A blood group was independently associated with CAD (odds ratio (OR): 1.422; 95% confidence interval (CI): 1.017–1.987; p = 0.039) and GS (β = 0.055, p = 0.046) in patients with poor BP control. Conclusions: A blood group was an independent risk factor for the presence and severity of CAD in hypertensive patients with poor BP control.     

Difference in 24‐hour urine sodium excretion between controlled and uncontrolled patients on antihypertensive drug treatment

The objective of this study was to evaluate the association between sodium intake and blood pressure (BP) control in hypertensive patients taking antihypertensive medications by using 24‐hour urine collection and 24‐hour ambulatory BP. This is a cross‐sectional community‐based study and conducted in 2011 and 2012. A total of 1128 participants were recruited from five cities in Korea. Among them, 740 participants who had complete 24‐hour urine collection and valid 24‐hour ambulatory BP data were included in this study. Participants were divided into four groups: normotensives (NT, n = 441), untreated hypertensive patients (UTHT, n = 174), controlled hypertensive patients (CHT, n = 62), and uncontrolled hypertensive patients (UCHT, n = 63). UCHT and CHT groups showed higher mean age than NT and UTHT groups. UCHT and UTHT groups showed higher 24‐hour systolic BP (SBP) and diastolic BP (DBP) than NT and CHT groups. UCHT group had the highest level of 24‐hour urine sodium. Multivariate analysis adjusted with age, gender, body mass index, estimated glomerular filtration rate, and use of diuretics showed higher level of 24‐hour urine sodium in UCHT group than that in CHT group. Multivariate logistic regression analysis revealed independent association of the amount of 24‐hour urine sodium with uncontrolled BP in hypertensive patients on antihypertensive drug treatment. Higher level of 24‐hour urine sodium excretion in uncontrolled hypertensive patients suggests that excessive sodium intake could be associated with blunted BP lowering efficacy of antihypertensive medications.     

The effects of radio-frequency ablation on blood pressure control in patients with atrial fibrillation and hypertension

Purpose

The effects of radio-frequency ablation (RFA) on blood pressure (BP) regulation in patients with atrial fibrillation (AF) and hypertension remain unknown. We hypothesized that patients with successful ablation had a lower BP and/or lesser utilization of antihypertensive drug therapy during follow-up when compared to patients with failed ablation.

Methods and results

This was a retrospective evaluation of patients with AF and hypertension treated with ablation at the University of Utah between July 2006 and June 2010. BP and use of antihypertensive medications were assessed at baseline and 1?year follow-up. A total of 167 patients were identified. Eight patients were excluded due to the need for AAD therapy beyond the blanking period thus leaving 80 patients in the success group and 79 patients in the failure group. The mean BP and HR at baseline were not significant between the groups. In the success group, the mean systolic BP decreased from a baseline value of 129?±?17 to 125?±?14?mmHg at 1?year (p?=?0.075). In contrast, in the failure group, the mean systolic BP increased from a baseline value of 124?±?16 to 127?±?14?mmHg at 1?year (p?=?0.176). Between-group comparison revealed a p value of 0.026. Minimal changes in diastolic BP were noted in both groups. No significant changes in antihypertensive therapy were noted.

Conclusion

We have shown that successful catheter ablation in patients with AF and hypertension is associated with a decrease in systolic BP when compared to an increase in patients with failed ablation. Our findings suggest that restoring sinus rhythm could have an antihypertensive effect in patients with AF and hypertension.     

Ethnic Variation in the Association of Hypertension With Type 2 Diabetes

Lifestyle changes occurring with urbanization increase the prevalence of both type 2 diabetes mellitus (T2DM) and hypertension (HTN). Yemenites who have immigrated to Israel have demonstrated a dramatic increase in T2DM but the prevalence of HTN in diabetic Yemenites is unclear. In a cross‐sectional study, the authors evaluated the prevalence of HTN and lifestyle patterns in Israelis with T2DM of Yemenite (Y‐DM) and non‐Yemenite (NY‐DM) origin. Y‐DM (n=63) and NY‐DM (n=120) had similar age (63±7 vs 64±7 years, P=.5), diabetes duration, diet adherence, and exercise patterns. Y‐DM had a lower prevalence of HTN (63%) than NY‐DM (83%) (P<.01). Furthermore, Yemenite origin was independently associated with lower prevalence of HTN (odds ratio, 0.3; 95% confidence interval, 0.12–0.71). Blood pressure was well controlled with fewer antihypertensive medications in Y‐DM than NY‐DM (P<.01). Even though lifestyle patterns were similar in the two groups, Y‐DM had a lower prevalence of HTN compared with NY‐DM and required fewer antihypertensive medications.     

Kidney volume and ambulatory blood pressure in children

Low nephron number has been shown to be a risk factor for hypertension (HTN) in adulthood. Kidney volume may serve as a surrogate marker for nephron mass. The relationship between kidney volume and ambulatory blood pressure (BP) in the pediatric population is not known. A retrospective chart review of children younger than 21 years who were evaluated for HTN was performed. Twenty‐four‐hour BP and ultrasonography data were obtained. Multiple regression was used to examine associations between BP and kidney volume. Of 84 children (mean age 13.87 years, 72.6% males), 54 had HTN. Systolic BP index during the awake, sleep, and 24‐hour periods (all P≤.05) was found to be positively correlated with total kidney volume. Greater total kidney volume was found to be a positive predictor of 24‐hour and sleep systolic index (P≤.05). It failed to serve as a predictor of HTN, pre‐HTN, or white‐coat HTN. Contrary to expectation, total kidney volume was positively associated with systolic BP indices.