Hypertension and New-Onset atrial Fibrillation in Participants with Diabetes Mellitus: A Report from the Population-Based kailuan Study

BACKGROUND Hypertension and diabetes mellitus are both known risk factors for atrial fibrillation (AF). Whether coexisting hypertension exacerbates AF risk among individuals with diabetes remains unclear. This study aims to investigate the association between hypertension and incident AF in this population. METHODS We studied participants in the prospective Kailuan Study, including 18,084 adults diagnosed with diabetes between 2006 and 2011 and free of AF at baseline. Hypertension was defined by a previous diagnosis, use of antihypertensive medications, or systolic/diastolic blood pressure ≥140/90 mmHg. Incident AF was identified via biennial ECGs and hospital records. Cox proportional hazards models adjusted for demographic, lifestyle, metabolic, and clinical covariates were used to estimate hazard ratios (HRs). RESULTS Over a median follow-up of 14.8 years (IQR 12.7–16.8), 275 participants with diabetes developed AF, and 5,265 died from any cause. Hypertension was associated with a higher risk of AF (adjusted HR, 1.48; 95% confidence interval [CI], 1.05–2.07) compared to those without hypertension. Compared to participants with normal blood pressure, the adjusted HRs for AF were 1.54 (95% CI, 1.11–2.13) for grade 1 hypertension and 1.61 (95% CI, 1.06–2.44) for grade 2 hypertension. Among those with hypertension, target organ damage—particularly prior myocardial infarction or ischemic stroke—further elevated AF risk (HR, 2.66; 95% CI, 1.26–5.60). CONCLUSIONS Hypertension independently increases AF risk in individuals with diabetes, especially with higher blood pressure levels and target organ damage. Early hypertension control is crucial for the prevention of AF in this high-risk population.