Baseline pr internal prolongation and elevated diastolic blood pressure are predictors of new-onset atrial fibrillation in hypertensive patients

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: One of the most significant risk factors for atrial fibrillation is hypertension (HTN) (AF). Although the PR interval is a factor in the Framingham risk score for AF, it has been linked to an elevated risk of incident AF. However, there is a lack of consistency in the findings identifying PR prolongation as a risk factor for AF. PURPOSE: In a large cohort of HTN patients, we seek to assess the predictive value of the PR interval for the emergence of AF. METHODS: The average follow-up time for consecutive individuals with essential hypertension and no known AF at baseline was 5.3 years. Each patient underwent a 12-lead ECG, an echocardiogram examination, and a 24-hour Holter rhythm monitoring in the event of arrhythmia complaints. These tests were done at baseline and once a year. The European Society of Cardiology/European Society of Hypertension guidelines for HTN therapy were followed during the follow-up period, including routine clinical and paraclinical assessments and drug administration. The baseline ECG was used to determine the PR interval and P wave length. RESULTS: We included 1807 hypertensives (mean age 57±11 years; 49% men) with office systolic/diastolic blood pressure of 144±17/89±11 mmHg. A total of 65 occurrences of new-onset AF (3%) were reported during the follow-up period. P wave duration and PR internal time were longer at baseline in patients with new-onset AF (n=67) compared to those without AF (n=1740) (P wave, 115 vs 110 ms) (PR interval, 174 vs 157 ms). A multivariate Cox regression analysis showed that baseline P wave duration had no significant prognostic value for the occurrence of new-onset AF, but baseline PR internal was substantially linked with the development of AF (HR = 1.01, 95% CI = 1.01-1.02; p = 0.01). A greater incidence of AF was linked to baseline elevated diastolic blood pressure (HR 1.05, 95% 1.003-1.091; p=0.037). CONCLUSIONS: Baseline PR internal and elevated diastolic blood pressure were significant predictors of new-onset AF in hypertensive patients. PR prolongation may be a marker for cardiovascular degenerative aging caused by vascular inflammation and myocardial fibrosis.