Response to Letter Regarding Article, “Influence of Systolic and Diastolic Blood Pressure on the Risk of Incident Atrial Fibrillation in Women”
We would like to thank Barrios et al for their interest in our study on the relationship between blood pressure and risk of incident atrial fibrillation.1 We also appreciate their positive comments on the potential impact of our article on future guidelines. Whereas a global approach on cardiovascular disease prevention is indeed essential, few studies have actually assessed this issue in patients who develop atrial fibrillation, and future studies are needed to define important risk factors for this highly prevalent disorder.
Barrios et al also raise an interesting point about a possible association between heart rate and incident atrial fibrillation. In a post-hoc analysis of the Losartan Intervention for End Point Reduction in Hypertension (LIFE) study, higher heart rate was associated with an increased risk of developing atrial fibrillation during follow-up,2 but we agree that it would be of interest to assess in greater detail the relationship between heart rate and incident atrial fibrillation. Unfortunately, data on heart rate were not systematically available in the Women’s Health Study, and we were therefore unable to further explore this important hypothesis. However, it is also important to point out that although multiple studies have shown an increased risk of cardiovascular disease in individuals with higher resting heart rates, pure modulation of heart rate has not been successful so far in a selected heart failure population.3