<p class="first" id="P1">Prior studies have reported that orthostatic hypotension
(OH) is associated with increased
risk of atrial fibrillation (AF). We sought to determine whether the association persists
after adjusting for hypertension and other cardiovascular risk factors. We studied
the Framingham Heart Study Original cohort participants evaluated between 1981 and
1984 without baseline AF. OH was defined as drop in standing systolic blood pressure
(BP) of at least 20 mm Hg or standing diastolic BP of at least 10 mm Hg from their
supine values after standing for 2 minutes. We estimated Cox proportional hazards
regression models to calculate multivariable-adjusted hazards ratios (HR) for association
between OH and risk of incident AF, adjusting for age, sex, seated systolic BP and
diastolic BP, resting heart rate, height, weight, current tobacco use, hypertension
treatment, diabetes, and history of myocardial infarction and heart failure. Of 1,736
participants (mean age, 71.7±6.5 years, 60% women) 256 (14.8%) had OH at baseline.
During 10 years follow-up, 224 participants developed new AF. In our multivariable-adjusted
model, OH (HR 1.61, 95% CI 1.17 to 2.20) and greater orthostatic decrease in mean
arterial pressure (MAP) (HR 1.11, 95% CI 1.02 to 1.22 per 8.6 mmHg change in MAP)
were both associated with higher risk of new AF. In conclusion, in our longitudinal
community-based sample, OH and orthostatic decline in MAP were significantly associated
with increased risk of incident AF after adjustment for systolic BP, diastolic BP,
and hypertension treatment.
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