Atrial Fibrillation in Hypertension

Verdecchia, Paolo; Reboldi, Gianpaolo; Gattobigio, Roberto; Bentivoglio, Maurizio; Borgioni, Claudia; Angeli, Fabio; Carluccio, Erberto; Sardone, Mariagrazia; Porcellati, Carlo

doi:10.1161/01.hyp.0000052830.02773.e4

Cited by 294 publications

(229 citation statements)

References 30 publications

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“…Compelling evidence shows that hypertensioninduced LA structural and functional alterations are associated with the presence of atrial fibrillation, 5 ischemic stroke [3][4][5] and congestive heart failure. 23 Thus, the recent (European Society of Cardiology) ESC/(European Society of Hypertension) ESH guidelines underscore the additive value of LA size determination for the risk stratification of hypertensives.…”

Section: Discussionmentioning

confidence: 99%

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Left ventricular mass but not geometry determines left atrial size in the early stages of hypertension

et al. 2009

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We investigated whether the type of left ventricular (LV) geometry is associated with left atrial (LA) size as determined either by LA diameter or by volume, indexed for body surface area, in essential hypertensives. A total of 339 consecutive, untreated, hypertensives (aged 51.8 years, 234 males) underwent 24-h ambulatory blood pressure (BP) monitoring and estimation of LA diameter and volume, as well as LV structure and function by echocardiography. LV hypertrophy was present in 130 (38.3%) patients whereas normal geometry (LV-NG), concentric remodeling (LV-CR), concentric hypertrophy (LV-CH) and eccentric hypertrophy (LV-EH) represented 34.5, 27.1, 25.7 and 12.7%, respectively. Patients with either LV-CH or LV-EH had increased LA diameter index compared with those with either LV-NG (by 1.1 mm m -2 , Po0.01 and 1.4 mm m -2 , P ¼ 0.003, respectively) or LV-CR (by 1.3 mm m -2 , P ¼ 0.003 and 1.6 mm m -2 , P ¼ 0.001, respectively). Similarly, patients with either LV-CH or LV-EH had significantly increased LA volume index compared with those with either LV-NG (by 3.2 ml m -2 , Po0.001 and 3.4 ml m -2 , Po0.005, respectively) or LV-CR (by 4.5 and 4.7 ml m -2 , respectively, Po0.001 for both). Multiple linear regression analysis showed that the independent predictors of both LA volume and diameter index were LV mass index, 24-h pulse pressure and E/Em.LA size assessed either by its diameter or by volume is closely related only to LV mass index and not to any specific LV geometric pattern in the early stages of essential hypertension.

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Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Nowadays, the focus on upstream therapies for atrial fibrillation targeting on its substrate makes the assessment of LA alterations an interesting issue.…”

Section: Introductionmentioning

confidence: 99%

Left ventricular mass but not geometry determines left atrial size in the early stages of hypertension

et al. 2009

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“…Hypertension and overt hyperthyroidism may cause to LVH in the course of their natural progression [11][12][13][14]. The cardiac effects of exogenous subclinical hyperthyroidism have been widely studied.…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of Left Ventricular Hypertrophy in Hypertensive Patients with Subclinical Hyperthyroidism

Tamer

Sargın

et al. 2005

Endocr J

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Abstract. The aim of this prospective cross-sectional study was to investigate the hypertrophic effects of endogenous subclinical hyperthyroidism on myocardium and early development of left ventricular hypertrophy (LVH) in essential hypertensive patients accompanied by endogenous subclinical hyperthyroidism. A total of 31 consecutive patients with stage I hypertension were included in the study. Sixteen of them also had endogenous subclinical hyperthyroidism that they were unaware before. The patients and the controls formed out of ten healthy subjects all underwent an investigation of thyroid functions and cardiologic evaluation. The mean wall thickness of the left ventricle in the stage I hypertensive group with endogenous subclinical hyperthyroidism (group I) was significantly increased as compared with both hypertensive patients without thyroid disease (group II) and the control subjects. The mean left ventricle mass was also significantly higher in group I than group II. Both of the patients' groups had an increased prevalence of LVH as compared with the controls. In this study, hypertensive patients with subclinical hyperthyroidism presented more increase in left ventricular mass, suggesting that subclinical hyperthyroidism may contribute to left ventricular hypertrophy forming a natural progression to hypertension. The hypertensive population should always be screened for endogenous subclinical hyperthyroidism, and should be examined for the criteria of left ventricular hypertrophy by echocardiography in early stages. SUBCLINICAL hyperthyroidism is characterized by persistently suppressed plasma thyroid stimulating hormone (TSH) concentrations and the presence of normal levels of free thyroxine (fT 4 ) and free triiodothyronine (fT 3 ) hormones. Subclinical hyperthyroidism can be the result of the same causes of overt clinical hyperthyroidism but patients with subclinical hyperthyroidism do not usually show specific symptoms and signs of hyperthyroidism [1,2]. It has been demonstrated that exogenous subclinical hyperthyroidism, in which patients treated with TSHsuppressive doses of levothyroxine, may affect the heart as in subjects with overt hyperthyroidism, but it remains controversial whether endogenous subclinical hyperthyroidism affects the heart [3][4][5].Situations in which thyroid hormones were increased have been shown to stimulate myocardial hypertrophy. Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity and mortality. Hypertension may also cause left ventricular myocardial hypertrophy. The importance of LVH in the prognosis of hypertension is well known because it clearly shows the duration and the severity of high blood pressure [6][7][8].Since hypertension and hyperthyroidism both may result in myocardial hypertrophy, we designed a crosssectional study to investigate the early development of LVH in essential hypertensive patients accompanied by endogenous subclinical hyperthyroidism. It could

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“…In the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) Study, age and left ventricular (LV) mass as measured by echocardiogram were independent predictors for new-onset AF after a mean follow-up period of 5.3 years. 9 The high prevalence of coexistent hypertension and AF is also reflected by the high proportion of hypertensive patients who require antihypertensive treatment (470%) and who are participating in major clinical trials on AF, such as the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study 10 and the Stroke Prevention Using an Oral Thrombin Inhibitor in Atrial Fibrillation (SPORTIF III) Study. 11 …”

Section: Atrial Fibrillationmentioning

confidence: 99%

Hypertension and cardiac arrhythmias: a review of the epidemiology, pathophysiology and clinical implications

Yiu

Tse

2008

J Hum Hypertens

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Hypertension is commonly associated with cardiac arrhythmias in patients with and without concomitant cardiovascular disease. Experimental and epidemiological studies have demonstrated potential links between hypertension and atrial and ventricular arrhythmias, although the underlying pathophysiological mechanism remains unclear. Nonetheless, the importance of hypertension as a cause of atrial and ventricular arrhythmias is not well recognized. In particular, the occurrence of left ventricular hypertrophy is a strong predictor for the development of AF, ventricular ectopy and sudden cardiac death. Recent prospective clinical trials reveal that antihypertensive therapy may delay or prevent the occurrence of cardiac arrhythmias and sudden cardiac death in patients with hypertension. Although antihypertensive agents that block the renin-angiotensin-aldosterone system appear to protect against cardiac arrhythmias, this needs to be confirmed by current ongoing clinical trials.

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Atrial Fibrillation in Hypertension

Cited by 294 publications

References 30 publications

Left ventricular mass but not geometry determines left atrial size in the early stages of hypertension

Left ventricular mass but not geometry determines left atrial size in the early stages of hypertension

The Evaluation of Left Ventricular Hypertrophy in Hypertensive Patients with Subclinical Hyperthyroidism

Hypertension and cardiac arrhythmias: a review of the epidemiology, pathophysiology and clinical implications

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