Accumulated hypertension burden on atrial fibrillation risk in diabetes mellitus: a nationwide population study

Choi, JungMin; Lee, So‑Ryoung; Choi, Eue‑Keun; Lee, HuiJin; Han, MinJu; Ahn, Hyo-Jeong; Kwon, Soonil; Lee, Seung-Woo; Han, Kyung‑Do; Oh, Seil; Lip, Gregory Y. H.

doi:10.1186/s12933-023-01736-4

Cardiovascular Diabetology

Table 2 Subgroup analyses according to hypertension burden group of 4

From: Accumulated hypertension burden on atrial fibrillation risk in diabetes mellitus: a nationwide population study

Subgroup	HTN burden	Number	AF
Subgroup	HTN burden	Number	Event	IR per 1000 PY	Adjusted HR*	p for interaction
Age
< 65	0	34,889	565	2.38	1 (Reference)	0.116
	1′	166,256	3336	2.94	1.13 (1.03–1.23)
	2′	96,778	2509	3.80	1.34 (1.22–1.48)
	3′	16,778	494	4.33	1.54 (1.35–1.75)
≥ 65	0	14,923	706	7.42	1 (Reference)
	1′	94,682	5096	8.43	1.08 (0.99–1.17)
	2′	76,478	4751	9.74	1.20 (1.11–1.31)
	3′	14,183	1038	11.53	1.39 (1.25–1.54)
Sex
Male	0	26,098	795	4.62	1 (Reference)	0.223
	1′	156,937	5319	5.13	1.07 (0.99–1.15)
	2′	104,696	4501	6.55	1.22 (1.13–1.32)
	3′	19,031	912	7.33	1.36 (1.23–1.51)
Female	0	23,714	476	2.96	1 (Reference)
	1′	104,001	3113	4.44	1.16 (1.05–1.28)
	2′	68,560	2759	5.99	1.33 (1.19–1.47)
	3′	11,930	620	7.78	1.60 (1.41–1.82)
CKD
No	0	45,003	1080	3.59	1 (Reference)	0.099
	1′	229,093	6663	4.35	1.07 (1.00- 1.14)
	2′	147,161	5585	5.69	1.23 (1.15–1.32)
	3′	25,805	1139	6.63	1.41 (1.29–1.55)
Yes	0	4809	191	6.04	1 (Reference)
	1′	31,845	1769	8.58	1.29 (1.11–1.50)
	2′	26,095	1675	10.07	1.42 (1.22–1.65)
	3′	5156	393	12.16	1.66 (1.39–1.98)
Prior MI or stroke
No	0	47,243	1151	3.64	1 (Reference)	0.799
	1′	244,447	7510	4.60	1.10 (1.03–1.17)
	2′	160,328	6408	6.01	1.26 (1.17–1.35)
	3′	28,568	1355	7.16	1.46 (1.33–1.60)
Yes	0	2569	120	7.39	1 (Reference)
	1′	16,491	922	8.80	1.13 (0.93–1.37)
	2′	12,928	852	10.45	1.27 (1.04–1.54)
	3′	2393	177	11.73	1.38 (1.09–1.75)
Insulin usage
No	0	42,828	1035	3.60	1 (Reference)	0.573
	1′	229,158	6941	4.53	1.08 (1.01–1.16)
	2′	153,770	6109	5.96	1.25 (1.16–1.34)
	3′	27,697	1298	7.06	1.44 (1.31–1.58)
Yes	0	6984	236	5.16	1 (Reference)
	1′	31,780	1491	7.25	1.19 (1.04–1.36)
	2′	19,486	1151	9.29	1.31 (1.14–1.52)
	3′	3264	234	11.43	1.51 (1.25–1.82)
Oral anti-diabetic medication ≥ 3
No	0	36,672	924	3.78	1 (Reference)	0.422
	1′	194,051	6048	4.68	1.08 (1.00–1.15)
	2′	132,145	5417	6.19	1.25 (1.16–1.34)
	3′	24,458	1178	7.30	1.44 (1.30–1.58)
Yes	0	13,140	347	3.93	1 (Reference)
	1′	66,887	2384	5.33	1.17 (1.04–1.31)
	2′	41,111	1843	6.73	1.29 (1.15–1.45)
	3′	6503	354	8.27	1.48 (1.27–1.73)
Thiazolidinediones
No	0	43,627	1125	3.88	1 (Reference)	0.300
	1′	231,529	7430	4.84	1.09(1.02 1.16)
	2′	155,954	6544	6.36	1.25 (1.17–1.34)
	3′	28,323	1392	7.47	1.44(1.31–1.58
Yes	0	6185	146	3.39	1 (Reference)
	1′	29,409	1002	4.94	1.22 (1.02–1.45)
	2′	17,302	716	6.04	1.28 (1.07–1.54)
	3′	2638	140	7.87	1.54 (1.22–1.95)
Dipeptidyl peptidase-4 inhibitors
No	0	41,899	1112	3.92	1 (Reference)	0.652
	1′	225,592	7488	4.92	1.09 (1.02–1.17)
	2′	154,525	6634	6.42	1.26 (1.17–1.35)
	3′	28,237	1421	7.57	1.45 (1.32–1.59)
Yes	0	7913	159	3.25	1 (Reference)
	1′	35,346	944	4.35	1.16 (0.98–1.37)
	2′	18,731	626	5.48	1.25 (1.05–1.49)
	3′	2724	111	6.75	1.44 (1.13–1.85)
DM duration ≥ 5 years
No	0	17,283	362	3.15	1 (Reference)	0.057
	1′	101,438	2599	3.86	1.04 (0.93–1.16)
	2′	71,014	2449	5.19	1.21 (1.08–1.35)
	3′	13,879	505	5.48	1.26 (1.10–1.46)
Yes	0	32,529	909	4.17	1 (Reference)
	1′	159,500	5833	5.48	1.13 (1.05–1.21)
	2′	102,242	4811	7.11	1.28 (1.18–1.38)
	3′	17,082	1027	9.17	1.55 (1.40–1.71)
Anti-hypertensive medication
No	0	36,331	758	3.09	1 (Reference)	0.950
	1′	132,152	3156	3.53	1.05 (0.97–1.14)
	2′	47,629	1368	4.24	1.15 (1.05–1.26)
	3′	5701	172	4.47	1.27 (1.07–1.51)
Yes	0	13,481	513	5.85	1 (Reference)
	1′	128,786	5276	6.26	1.06 (0.97–1.16)
	2′	125,627	5892	7.14	1.17 (1.06–1.29)
	3′	25,260	1360	8.20	1.33 (1.19–1.49)
ACEi/ARB
No	0	37,079	799	3.20	1 (Reference)	0.807
	1′	151,812	4009	3.91	1.08 (1.00–1.17)
	2′	72,916	2567	5.21	1.24 (1.14–1.35)
	3′	11,043	447	5.98	1.40 (1.23–1.58)
Yes	0	12,733	472	5.70	1 (Reference)
	1′	109,126	4423	6.21	1.08 (0.98–1.19)
	2’	100,340	4693	7.16	1.21 (1.09–1.33)
	3′	19,918	1085	8.38	1.39 (1.24–1.56)

ACEi Angiotensin-converting enzyme inhibitors, ARB Angiotensin II Receptor Blockers, AF atrial fibrillation, CKD chronic kidney disease, DM diabetes mellitus, HR hazard ratio, HTN hypertension, IR incidence rate, MI myocardial infarction, PY person-year
^*Adjusted HR: Model 5 (adjustment of age, sex, CKD, dyslipidemia, heart failure, prior MI, prior stroke, smoking, alcohol, regular exercise, low income, DM duration over 5 years, insulin usage, more than 3 oral antidiabetic medications, SBP, fasting glucose, total cholesterol, and BMI at latest (index) health examination)

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