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


The incidence of atrial fibrillation (AF) and risk of cardiovascular events are reportedly higher in patients with primary aldosteronism (PA) than essential hypertension. However, associated factors of comorbid AF and cardiovascular events in PA patients after PA treatment remain unclear. This nationwide registration study included PA patients ≥20 years old. Incident cardiovascular events were observed with a mean follow-up of approximately 3 years. A total of 3654 patients with PA were included at the time of analysis. 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 factors associated with 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 older age, duration of hypertension, body mass index and chronic kidney disease as independent prognostic factors for cardiovascular events after PA treatment. Incidence of cardiovascular events were significantly lower in PA patients with AF than AF patients from the Fushimi registry during follow-up after adjusting age, sex and systolic blood pressure. Early diagnosis of PA may prevent AF and other cardiovascular events in PA patients by shortening the duration of hypertension and appropriate PA treatment.

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Fig. 1: The study flow chart shows final subtype diagnosis of primary aldosteronism was achieved by adrenal vein sampling in 4050 patients.
Fig. 2: Kaplan–Meier cumulative incidence curves for the composite end point of cardiovascular events including myocardial infarction, congestive heart failure, cerebral hemorrhage or cerebral infarction in the entire population.
Fig. 3: Kaplan–Meier cumulative incidence curves for the composite end point of cardiovascular events including myocardial infarction, congestive heart failure, cerebral hemorrhage or cerebral infarction in the entire population.


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We wish to thank the JPAS/JRAS study members for collecting the clinical data. We are grateful to Keiko Umegaki (Kyoto Medical Center) and Kazuho Ikedo (Mie University) for their excellent technical assistance and the Fushimi AF registry investigators for their great help in revising this paper.


This work was supported by the Japan Agency for Medical Research and Development (AMED) (grant numbers JP17ek0109112 and JP20ek0109352 to MN), Grants-in-Aid for Scientific Research from the Ministry of Education, Science, Technology, Sports and Culture, Japan, and the Mie Medical Foundation (grant number 19K08578 to RO and KD) and the National International Center for Health and Global Medicine, Japan (grant number 30–1008 to AT).

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RO and SS designed this study and carried out the analyses; RO, SS and MN drafted and revised the manuscript; and CI, MA, KK, IK, YT, YO, TK, MT, SF collected the data; NI, HR, AT, KT, YY, KD managed and advised for the study and the manuscript.

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Correspondence to Ryuji Okamoto.

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Sakaguchi, S., Okamoto, R., Inoue, C. et al. Associated factors and effects of comorbid atrial fibrillation in hypertensive patients due to primary aldosteronism. J Hum Hypertens (2022).

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