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Hypertension control and end-stage renal disease in atrial fibrillation: a nationwide population-based cohort study

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Abstract

Background

The impact of hypertension control on the risk of end-stage renal disease (ESRD) in patients newly diagnosed with atrial fibrillation (AF) is unknown. This study aimed to investigate the impact of hypertension control on incident ESRD among AF patients.

Methods

From the National Health Information database of Korea, we identified ESRD-free patients who were newly diagnosed with AF during 2010 and 2016. The patients were divided into four groups (NN, NH, HN, and HH) according to combinations of dichotomous blood pressure status [normotensive (N) or hypertensive (H)] of two consecutive check-ups. The primary outcome was incident ESRD. Cox proportional hazard regression analysis evaluated ESRD risks across the groups. The association between ESRD risks and changes in blood pressures was also evaluated.

Results

During the mean follow-up duration of 3.2 ± 1.9 years, 130,259 ESRD-free patients with AF (mean age 63.1 ± 12.1 years, male 61.2%) were evaluated. Compared to NN, other patient groups showed higher ESRD risks [hazard ratio (95% confidence interval) = 1.43 (1.08–1.89), 1.39 (1.08–1.79), and 2.03 (1.55–2.65) for NH, HN, and HH, respectively]. There was a significant trend of decreasing risks of ESRD in patients with greater reductions in systolic blood pressure after AF diagnosis (p for-trend < 0.001). The association between hypertension control and the ESRD risk was more accentuated in patients with chronic kidney disease.

Conclusion

Uncontrolled hypertension was associated with an increased risk of incident ESRD in patients with newly diagnosed AF. This study emphasizes the importance of blood pressure control once patients are diagnosed with AF to prevent ESRD.

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Availability of data and materials

All raw data are accessible from the designated terminals approved by the National Health Insurance Sharing Service.

Abbreviations

AF:

Atrial fibrillation

BP:

Blood pressure

CI:

Confidence interval

CKD:

Chronic kidney disease

ESRD:

End-stage renal disease

HR:

Hazard ratio

eGFR:

Estimated glomerular filtration rate

SBP:

Systolic blood pressure

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Funding

This study was supported by grant no 3020200190 from the Seoul National University Hospital Research Fund, by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, Republic of Korea, the Ministry of Food and Drug Safety) (Project Number: 202013B14), and by the Korea National Research Foundation funded by the Ministry of Education, Science and Technology (grant 2020R1F1A106740).

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Authors and Affiliations

Authors

Contributions

Conceptualization: SK, SRL, EKC, JHJ, KDH, GYHL, and OS, data curation: SK, SRL, EKC, JHJ, KDH, GYHL, and OS, formal analysis: SK, SRL, EKC, JHJ, KDH, GYHL, and OS, funding acquisition: EKC, investigation: SK, SRL, EKC, JHJ, and KDH, methodology: SK, SRL, EKC, JHJ, KDH, GYHL, and OS, project administration: EKC, and KDH, resources: SRL, EKC, and KDH, software: SK, SRL, JHJ, and KDH, supervision: SRL, EKC, KDH, GYHL, and OS, validation: SK, SRL, EKC, JHJ, and KDH, visualization: SK and JHJ, writing—original draft: SK and SRL, figure and table generation: SK and SRL, writing—review and editing: SK, SRL, EKC, JHJ, KDH, GYHL and OS. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Eue-Keun Choi.

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Conflict of interest

SK, SRL, JHJ, KDH, SO: none to disclose. EKC: research grants from Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daiichi-Sankyo, Samjinpharm, Sanofi-Aventis, Seers Technology, Skylabs, and Yuhan. No fees are received personally. GYHL: consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo. Speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are received personally.

Ethical approval consent to participate

The Institutional Review Board of Seoul National University Hospital approved the study (No. 2008–048-1147) and adhered to the Declaration of Helsinki. Informed consent was exempted because the study used anonymous data.

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Kwon, S., Lee, SR., Choi, EK. et al. Hypertension control and end-stage renal disease in atrial fibrillation: a nationwide population-based cohort study. Clin Res Cardiol 111, 284–293 (2022). https://doi.org/10.1007/s00392-021-01899-8

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  • DOI: https://doi.org/10.1007/s00392-021-01899-8

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