老年房颤合并高血压患者强化降压治疗的研究进展

姜 博¹, 贺 利平²
1、内蒙古医科大学
2、内蒙古自治区人民医院心血管内科

摘要

心房颤动（Atrial fibrillation，AF）和高血压（Hypertension）是两种常见的心血管疾病，两种疾病患病率高，且经
常出现在老年患者中。二者相互共存，互相影响，其中高血压是引起心房颤动的独立危险因素之一，占其发病因素中的14% ，与此同时心房颤动的患者多数合并有高血压，数据高达53%。由于两种疾病严重影响老年患者生存周期，近几年国内外指
南表明更为严格的降压目标实施后对于老年患者的生存受益良多。故笔者对老年心房颤动合并高血压患者强化降压治疗效果
的研究进展做一综述加以总结。

关键词

强化降压；高血压；心房颤动

参考

[1]Kallistratos M S, Poulimenos L E, Manolis A J. Atrial

fibrillation and arterial hypertension [J]. Pharmacol Res, 2018, 128: 322-326. [2]Emdin C A, Anderson S G, Salimi-Khorshidi G, et al. Usual blood pressure, atrial fibrillation and vascular risk:

evidence from 4.3 million adults [J]. Int J Epidemiol, 2017, 46(1): 162-172. [3]Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a

systematic analysis for the Global Burden of Disease Study

2017 [J]. Lancet, 2019, 394(10204): 1145-1158. [4]Fuster V, Rydén L E, Cannom D S, et al. ACC/AHA/ESC 2006 Guidelines for the Management of

Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology

Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm

Society [J]. Circulation, 2006, 114(7): e257-354. [5]Verdecchia P, Angeli F, Reboldi G. Hypertension and

Atrial Fibrillation: Doubts and Certainties From Basic and

Clinical Studies [J]. Circ Res, 2018, 122(2): 352-368. [6]Whelton P K, Carey R M, Aronow W S, et al. 2017

ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA

/PCNA Guideline for the Prevention, Detection, Evaluation, and

Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [J]. Hypertension, 2018, 71(6): e13-e115. [7]Wright J T, Jr., Williamson J D, Whelton P K, et al. A

Randomized Trial of Intensive versus Standard Blood-Pressure Control [J]. N Engl J Med, 2015, 373(22): 2103-2116. [8]Soliman E Z, Rahman A F, Zhang Z M, et al. Effect of

Intensive Blood Pressure Lowering on the Risk of Atrial

Fibrillation [J]. Hypertension, 2020, 75(6): 1491-1496. [9]Sobieraj P, Nilsson P M, Kahan T. Heart Failure Events

in a Clinical Trial on Arterial Hypertension: New Insights Into

the SPRINT Trial [J]. Hypertension, 2021, 78(5): 1241-1247. [10]Parcha V, Patel N, Kalra R, et al. Incidence and

Implications of Atrial Fibrillation/Flutter in Hypertension: Insights From the SPRINT Trial [J]. Hypertension, 2020, 75(6): 1483-1490. [11]Zhang W, Zhang S, Deng Y, et al. Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension [J]. N Engl J Med, 2021, 385(14): 1268-1279. [12]Pinho-Gomes A C, Azevedo L, Copland E, et al. Blood

pressure-lowering treatment for the prevention of cardiovascular events in patients with atrial fibrillation: An individual

participant data meta-analysis [J]. PLoS Med, 2021, 18(6): e1003599. [13]Verdecchia P, Staessen J A, Angeli F, et al. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial [J]. Lancet, 2009, 374(9689): 525-533. [14]Thomas M C, Dublin S, Kaplan R C, et al. Blood

pressure control and risk of incident atrial fibrillation [J]. Am J

Hypertens, 2008, 21(10): 1111-1116. [15]Heijman J, Voigt N, Nattel S, et al. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression [J]. Circ Res, 2014, 114(9): 1483- 1499.[16]Qiu D, Peng L, Ghista D N, et al. Left Atrial

Remodeling Mechanisms Associated with Atrial Fibrillation [J]. Cardiovasc Eng Technol, 2021, 12(3): 361-372. [17]Nattel S, Burstein B, Dobrev D. Atrial remodeling and

atrial fibrillation: mechanisms and implications [J]. Circ Arrhythm Electrophysiol, 2008, 1(1): 62-73. [18]Huang Z, Zheng Z, Wu B, et al. Predictive value of P wave terminal force in lead V1 for atrial fibrillation: A meta- analysis [J]. Ann Noninvasive Electrocardiol, 2020, 25(4): e12739. [19]Kamel H, Hunter M, Moon Y P, et al. Electrocardiographic Left Atrial Abnormality and Risk of

Stroke: Northern Manhattan Study [J]. Stroke, 2015, 46(11): 3208-3212.

[20]Kamel H, Rahman A F, O'Neal W T, et al. Effect of

intensive blood pressure lowering on left atrial remodeling in

the SPRINT [J]. Hypertens Res, 2021, 44(10): 1326-1331. [21]Chen L Y, Bigger J T, Hickey K T, et al. Effect of

Intensive Blood Pressure Lowering on Incident Atrial

Fibrillation and P-Wave Indices in the ACCORD Blood

Pressure Trial [J]. Am J Hypertens, 2016, 29(11): 1276-1282. [22]Cuspidi C, Tadic M, Grassi G, et al. Treatment of

hypertension: The ESH/ESC guidelines recommendations [J]. Pharmacol Res, 2018, 128: 315-321. [23]Hindricks G, Potpara T, Dagres N, et al. 2020 ESC

Guidelines for the diagnosis and management of atrial

fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task

Force for the diagnosis and management of atrial fibrillation of

the European Society of Cardiology (ESC) Developed with the

special contribution of the European Heart Rhythm Association

(EHRA) of the ESC [J]. Eur Heart J, 2021, 42(5): 373-498. [24]January C T, Wann L S, Calkins H, et al. 2019

AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS

Guideline for the Management of Patients With Atrial

Fibrillation: A Report of the American College of

Cardiology/American Heart Association Task Force on Clinical

Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons [J]. Circulation, 2019, 140(2): e125-e151. [25]Chatap G, Giraud K, Vincent J P. Atrial fibrillation in

the elderly: facts and management [J]. Drugs Aging, 2002, 19(11): 819-846.