Atrial Fibrillation in Patients With Hypertension

Abstract

A trial fibrillation (AF) is the commonest sustained cardiac arrhythmia, with an increasing prevalence and incidence with age and associated cardiovascular comorbidities.1 The prevalence and incidence of hypertension also increases with increasing age, and hypertension is the commonest pathogenic risk factor for the development of AF. The development of AF is most evident in the presence of hypertensive left ventricular hypertrophy, especially where there is associated heart failure with preserved ejection fraction.Not only does hypertension increase the risk of incident AF but also both conditions commonly coexist in the same patient.1 Both conditions individually lead to complications, such as stroke and heart failure, with the risks accentuated when both the disorders are present. Other epidemiological links are also evident, with the intimate relationship of AF and hypertension individually to coronary artery disease (especially myocardial infarction), obesity, and obstructive sleep apnea and to alcohol excess. Associated renal dysfunction or proteinuria (commonly seen in association with hypertension) can predispose to the development of AF.1 Uncontrolled hypertension leads to more strokes, whether in AF or non-AF patients. When anticoagulants are used, uncontrolled blood pressure increases the risk of serious bleeding. 2Underlying these epidemiological relationships are the pathophysiological similarities.1 AF confers a prothrombotic or hypercoagulable state, leading to the higher risk of thromboembolism.3 A prothrombotic state is also seen with hypertension, given the observation that despite the blood vessels being exposed to high pressures the complications of hypertension, that is, stroke and myocardial infarction are paradoxically thrombotic, rather than hemorrhagic (the Birmingham paradox).4 AF is more common with diastolic dysfunction (often in association with atrial dilatation, left ventricular hypertrophy, and cardiac fibrosis), and hypertension is the commonest predisposing factor leading to diastolic dysfunction, often with associated left ventricular hypertrophy. Systemic vascular dysfunction (as quantified by abnormal flow-mediated dilatation or other biomarkers) is evident in hypertension, and it is also related to AF.In this issue of Hypertension, Rahman et al 5 report that among 4351 Framingham Study participants, longitudinal disease patterns, referred to as trajectories, of AF risk could be related to the development of AF. The highest risks of incident AF were seen with group 4 (hypertensive initially with decreasing BP) and group 5 (hypertensive and increasing BP) for systolic blood pressures, particularly where longer antihypertensive treatment was needed. Interestingly, distinct trajectories for diastolic blood pressure, smoking, and diabetes mellitus were not associated with increased 15-year risk of AF. The authors conclude that longitudinal trajectories (ie, longitudinal systolic blood pressure data) may distinguish how exposures related to AF contribute toward the prospective ris...

Atrial fibrillation: risk factors and comorbidities in a tertiary center in Jeddah, Saudi Arabia

“…In the present study, regression analysis showed that HTN was significantly correlated with HF and DM. HTN not only causes AF, but also increases the risk of AF complications, particularly HF and embolic cerebrovascular stroke 31. In this study, hypertensive patients with AF were at three times more risk of developing HF than nonhypertensive patients ( P <0.005) and four times more likely to have comorbid T2DM ( P <0.001).…”

Left atrial strain - an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation

“…Though assessing ventricular function is essential, there is robust data that atrial function is also important and can improve our decision making by determining the risk of cardiovascular events in various conditions [ 1 ]. Hypertension is the most common predisposing factor for left ventricular (LV) diastolic dysfunction (DD), which leads to increased left atrial (LA) pressure, its enlargement and fibrosis as well as other proarrhythmic pathological effects on atrial structure and function [ 2 , 3 ]. These changes cause various cardiac arrhythmias, most commonly atrial fibrillation (AF), an arrhythmia that carries a substantial risk of embolic events.…”

Malignant hypertension: does this still exist?

“…In the heart, the impairment of cardiac structure and function is so evident that it is referred as hypertensive heart disease [26]. It includes left ventricular hypertrophy, cardiomegaly, systolic and diastolic dysfunction, and finally heart failure [9,27]. Even atrial fibrillation is said to be a certain presentation of TOD [27].…”

“…It includes left ventricular hypertrophy, cardiomegaly, systolic and diastolic dysfunction, and finally heart failure [9,27]. Even atrial fibrillation is said to be a certain presentation of TOD [27].…”