Global population epidemiology research shows that by 2019, there were 1.28 billion hypertensive patients, and about 59.7 million patients with atrial fibrillation (AF) worldwide. Hypertension greatly increases the risk of AF. And in older hypertensive patients, the incidence of AF will be higher than 60%. Moreover, AF increases the risk of ischemic stroke, heart failure, myocardial infarction, chronic kidney disease and dementia. However, there are few studies on whether AF increases the risk of new-onset myocardial infarction, and whether the risk interacts with age is still unclear in large hypertensive populations.

To examine whether AF increases the risk of new-onset myocardial infarction in hypertensive patients.

Individuals with hypertension were selected as subjects from the employees of Kailuan Group who underwent the medical check-up in Tangshan Gongren Hospital and Kailuan General Hospital from June 2006 to October 2007. General data and laboratory test results of subjects were collected. And all of them were regularly followed up until 2020-12-31. The endpoint event was new-onset myocardial infarction. The finally enrolled cases (n=42 833) included 270 with AF diagnosed by baseline ECG (AF group) and 42 563 without (non-AF group) . The cumulative incidence of myocardial infarction was calculated by the life table method. The survival curve for the cumulative incidence of new-onset myocardial infarction was plotted by Kaplan-Meier method. The difference of the cumulative incidence of myocardial infarction between AF and non-AF groups was compared by Log-rank test. Multivariate Cox proportional hazards regression model was used to investigate the effect of AF on new-onset myocardial infarction in hypertension.

AF group had greater mean age, and lower mean levels of diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol than non-AF group (P<0.05) . There were also statistically differences in the incidence of myocardial infarction and cumulative incidence of new-onset myocardial infarction between the two groups (P<0.05) . After age-stratification, it was found that the differences in the incidence of new-onset myocardial infarction and cumulative incidence of myocardial infarction were statistically significant between those aged ≤60 years with AF and without AF (P<0.05) , but were insignificant between those aged > 60 years with and without AF (P>0.05) . Adjusted multivariate Cox proportional hazards regression analysis showed that AF was a risk factor for new-onset myocardial infarction in hypertensive population〔HR=2.89, 95%CI (1.74, 4.82) , P<0.01〕, and also in hypertensive population aged ≤60 years old〔HR=4.72, 95%CI (2.11, 10.56) , P<0.01〕.

AF is a risk factor for new-onset myocardial infarction in hypertensive population, especially in those ≤60 years old. Active control of blood pressure and treatment of AF are important prevention and treatment measures for new-onset myocardial infarction.

全球人群流行病学研究显示：截至2019年全球高血压患者已达12.8亿，心房颤动患者约5 970万例。高血压极大增加了心房颤动的发生风险，特别是老年高血压患者心房颤动的发生率将高于60%。同时心房颤动增加了缺血性卒中、心力衰竭、心肌梗死、慢性肾脏病及痴呆的发病风险。对于庞大的高血压人群，罹患心房颤动是否增加新发心肌梗死发病风险目前研究尚少，且其风险是否与年龄存在交互作用，目前尚不明确。

分析高血压人群中罹患心房颤动是否增加新发心肌梗死发病风险。

选取2006年6月至2007年10月开滦集团职工于唐山市工人医院和开滦总医院健康查体人群中高血压患者为研究对象，收集所有研究对象的一般资料与实验室检查结果，并定期进行随访，随访截至2020-12-31，终点事件为患者新发心肌梗死。最终42 833例患者纳入研究，依据患者基线心电资料是否诊断为心房颤动将患者分为心房颤动组（n=270）和非心房颤动组（n=42 563）。用寿命表法计算患者心肌梗死事件的累积发病率，采用Kaplan-Meier法绘制心房颤动组与非心房颤动组新发心肌梗死累积发病率的生存曲线，并用Log-rank检验比较两组患者新发心肌梗死累积发病率的差异。采用多因素Cox比例风险回归模型分析探究高血压人群罹患心房颤动对新发心肌梗死的影响。

心房颤动组患者年龄高于非心房颤动组，舒张压、总胆固醇（TC）、三酰甘油、低密度脂蛋白胆固醇低于非心房颤动组（P<0.05）；心房颤动组与非心房颤动组患者心肌梗死发生率和累积发病率比较，差异有统计学意义（P<0.05）。将所有患者按年龄进行分层，≤60岁患者心房颤动组与非心房颤动组新发心肌梗死发病率和累积发病率比较，差异有统计学意义（P<0.05）；>60岁患者心房颤动组与非心房颤动组新发心肌梗死发病率和累积发病率比较，差异无统计学意义（P>0.05）。经校正后的多因素Cox比例风险回归模型分析结果显示，高血压人群罹患心房颤动是新发心肌梗死的危险因素〔HR=2.89，95%CI（1.74，4.82），P<0.01〕，≤60岁高血压人群罹患心房颤动是新发心肌梗死的危险因素〔HR=4.72，95%CI（2.11，10.56），P<0.01〕。

高血压人群罹患心房颤动是新发心肌梗死的危险因素，特别是对于年龄≤60岁高血压人群，积极控制血压、治疗心房颤动是新发心肌梗死的重要防治措施。