Predictors and effects of comorbid atrial fibrillation in hypertensive patients due to primary aldosteronism

Objective: The incidence of atrial fibrillation (AF) and risk of cardiovascular events are reportedly higher in patients with primary aldosteronism (PA) than those with essential hypertension. This study sought to determine independent predictors of comorbid AF and cardiovascular events in PA patients after PA treatment. Design and method: This nationwide registration study included PA patients more than 20 years old. Incident cardiovascular events were observed with a mean follow-up of approximately 3 years. A total of 3,654 patients with PA were included at the time of analysis. Results: Prevalence of AF was 2.4%. PA patients with AF were older, more frequently male and had longer duration of hypertension than those without AF. No significant difference in basal plasma and adrenal venous aldosterone concentration, renin activity, potassium concentration, confirmatory tests of PA, laterality or surgery rate were seen between groups. Logistic regression analysis showed age, male sex, cardiothoracic ratio, past history of coronary artery disease and heart failure were independent determinants for AF. PA patients with AF showed a higher frequency of cardiovascular events than those without AF (P < 0.001). Multivariate Cox analyses demonstrated AF in addition to duration of hypertension, older age, male sex, hypokalemia and surgery as independent prognostic factors for cardiovascular events (hazard ratio [HR] 1.866, 95% confidence interval [CI] 1.024–3.401, P < 0.05; HR 1.022, 95%CI 1.006–1.039, P < 0.01; HR 1.424, 95%CI 1.043–1.943, P < 0.05; HR 1.027, 95%CI 1.012–1.042, P = 3.2 × 10 –4 ; HR 1.726, 95%CI 1.226–2.430, P < 0.005; HR 1.458, 95%CI 1.041–2.041, P < 0.05, respectively). After PA treatment, incidence of cardiovascular events did not differ significantly between PA patients with AF and essential hypertension patients with AF from the Fushimi registry during follow up after adjusting age, sex and prevalence of hypertension. Conclusion: Early diagnosis of PA may prevent AF and other cardiovascular events in PA patients by shortening the duration of hypertension.