More intense blood pressure control may lower irregular heartbeat risk

Aggressively treating high blood pressure might reduce the risk of a type of irregular heartbeat, according to a new study.

Atrial fibrillation, or AFib, can lead to stroke, heart failure and other cardiovascular complications. The condition is on the rise, with an estimated 12.1 million Americans expected to have it in 2030. The most common modifiable risk factor for AFib is high blood pressure, which affects 46% of U.S. adults.

The study, published Monday in the American Heart Association journal Hypertension, sought to find out if intensively lowering a person's blood pressure to normal might prevent them from developing AFib.

The study included 8,022 people who had high blood pressure and were at increased risk of cardiovascular disease, but who didn't have AFib. Half underwent aggressive treatment with different levels of medicines aiming to lower systolic blood pressure, the top number in the measurement, to below 120. The other half underwent treatment to lower blood pressure to below 140.

During five years of follow-up, 88 people in the aggressive-treatment group developed AFib, compared to 118 in the standard-treatment group. That translated to a 26% lower risk of AFib for those whose blood pressure was treated aggressively.

"Our results present a path for prevention of AFib in people with hypertension," said the study's lead author, Dr. Elsayed Z. Soliman, director of the Epidemiological Cardiology Research Center at Wake Forest School of Medicine in Winston-Salem, North Carolina.

He said the findings are particularly meaningful because there's currently no specific medication available to prevent the heart rhythm disorder in people with high blood pressure.

"As the population ages, the number of people with AFib is expected to double," Soliman said. "Management of AFib risk factors is of the utmost importance, especially high blood pressure because of the increasing number of people who have it."

He said the study was limited by the technical constraints of the electrocardiogram, a test used to diagnose AFib that measures the electrical activity of the heartbeat. "It's an elusive disease. … We probably missed some cases of AFib," Soliman said.

He'd like to see future studies examine whether aggressive blood pressure lowering also can reduce "downstream complications of AFib, such as stroke, heart attack and heart failure."

Dr. Mina Chung, who was not involved in the research, called it "an important study."

"There are a lot of observational studies that show associations of AFib with hypertension, but this is one of the first randomized studies to demonstrate that if you lower blood pressure through intensive measures, an AFib endpoint is lower," said Chung, a cardiologist and director of the Cleveland Clinic's Center of Excellence for Cardiovascular Translational Functional Genomics.

In addition to lowering their blood pressure, people can do a number of things to lower AFib risk, said Chung, who led the writing of an AHA scientific statement about AFib prevention published in March.

"The data," she said, "supports trying to lose weight for those who are overweight or obese, screening for and treating obstructive sleep apnea, and working toward 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise."

And now, she added, "there are stronger data supporting more aggressive control of blood pressure."

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