Time-Dependent Risk of Atrial Fibrillation in Patients With Primary Aldosteronism After Medical or Surgical Treatment Initiation
- Authors
- Kim, Kyoung Jin; Hong, Namki; Yu, Min Heui; Lee, Hokyou; Lee, Seunghyun; Lim, Jung Soo; Rhee, Yumie
- Issue Date
- Jun-2021
- Publisher
- Lippincott Williams & Wilkins Ltd.
- Keywords
- adrenalectomy; atrial fibrillation; cardiovascular diseases; hypertension; hyperaldosteronism; stroke
- Citation
- Hypertension, v.77, no.6, pp 1964 - 1973
- Pages
- 10
- Indexed
- SCIE
SCOPUS
- Journal Title
- Hypertension
- Volume
- 77
- Number
- 6
- Start Page
- 1964
- End Page
- 1973
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/53473
- DOI
- 10.1161/HYPERTENSIONAHA.120.16909
- ISSN
- 0194-911X
1524-4563
- Abstract
- Increased risk of atrial fibrillation was reported in patients with primary aldosteronism. However, data are limited regarding the time-dependent risk of atrial fibrillation in surgically or medically treated primary aldosteronism. From the National Health Insurance Claim database in Korea (2003-2017), a total of 1418 patients with primary aldosteronism (adrenalectomy [ADX], n=755, mineralocorticoid receptor antagonist n=663) were age- and sex-matched at a 1:5 ratios to patients with essential hypertension (n=7090). Crude incidence of new onset atrial fibrillation was 2.96% in primary aldosteronism and 1.97% in essential hypertension. Because of nonproportional hazard observed in new onset atrial fibrillation, analysis time was split at 3 years. Compared with essential hypertension, risk of new onset atrial fibrillation peaked at 1 year gradually declined but remained elevated up to 3 years in overall treated primary aldosteronism (adjusted hazard ratio [aHR] 3.02; P<0.001) as well as in both ADX (aHR, 3.54; P<0.001) and mineralocorticoid receptor antagonist groups (aHR 2.27; P=0.031), which became comparable to essential hypertension afterward in both groups (ADX aHR, 0.38; P=0.102; mineralocorticoid receptor antagonist aHR, 0.60; P=0.214). Nonetheless, mineralocorticoid receptor antagonist group was associated with increased risk of nonfatal stroke (aHR, 1.21; P=0.031) compared with essential hypertension, whereas ADX was not (aHR, 1.26; P=0.288). Our results suggest the risk of new-onset atrial fibrillation remained elevated up to 3 years in treated primary aldosteronism compared with essential hypertension, which declined to comparable risk in essential hypertension thereafter. Monitoring for atrial fibrillation up to 3 years after treatment, particularly ADX, might be warranted.
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- Appears in
Collections - 2. Clinical Science > Department of Endocrinology and Metabolism > 1. Journal Articles
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