Different Influence of Blood Pressure on New-Onset Atrial Fibrillation in Pre-and Postmenopausal Women: A Nationwide Population-Based Study

The characteristics of hypertension in pre-and postmenopausal women are different. Hypertension is a known risk factor for new-onset atrial fibrillation (AF), but its interaction with the menopause state is not fully established. We investigated whether menopause influences the adverse impact of high blood pressure on new-onset AF using a nationwide population-based cohort in Korea. People who underwent both a national health check-up and national cancer screening program were included in this study. A total of 3 280 834 women were assessed with 23 781 070 person∗year follow-up data. Menopause was observed in 1 439 161 women. The risk of new-onset AF and blood pressure showed a linear relationship in premenopausal women (P<0.001 for both systolic and diastolic blood pressure). The risk of new-onset AF was increased by 58.8% if systolic blood pressure was ≥160 mm Hg compared with the reference group (100 mm Hg ≤ systolic blood pressure <110 mm Hg; hazard ratio=1.588 [95% CI, 1.383-1.823]) in premenopause group. However, no consistent correlation was observed between blood pressure and the risk of new-onset AF in postmenopausal women. The increased risk of new-onset AF attributable to elevated blood pressure was more pronounced in patients not taking antihypertension medications (P for interaction <0.001). In conclusion, elevated blood pressure, especially systolic blood pressure, was a significant risk factor for new-onset AF in premenopausal women. Postmenopausal women showed a significantly attenuated association between blood pressure and the risk of new-onset AF. Elevated systolic blood pressure had a more profound impact on new-onset AF in women not taking medications for hypertension.