Hypertension and Cardiac Arrhythmias

Abstract

Arterial hypertension is a widespread disease and one of important yet under-recognized and under-treated causes of atrial and ventricular arrhythmias. Hypertrophy of cardiac muscle in hypertensive patients is characterized not only by increased myocardial mass, but also by proliferation of fibrous tissue and decreased intercellular coupling, that lead to inhomogeneity of electrical properties and propensity to various arrhythmias. Many trials show the importance of treating hypertension in order to restore normal myocardial function and decrease the number of premature beats, runs of ventricular tachycardia, and attacks of atrial fibrillation. To date, the most convincing data are collected regarding the importance of blockade of renin-angiotensin-aldosterone system (RAAS) in order to avoid arrhythmias in arterial hypertension. Other antihypertensive drug classes (eg beta-blockers, calcium antagonists) are also useful, and investigational compounds that aim at regression of hypertrophy are under search. Polymorphism of genes coding the function of RAAS, pathways of synthesis and degradation of proteins and other cardiac and extracardiac systems involved in regulation of blood pressure, are recognized as promising targets for research.

Atrial Fibrillation and CHADS2 Risk Factors are Associated with Highly Sensitive C‐Reactive Protein Incrementally and Independently

“…Proposed mechanisms include atrial stretch, atrial fibrosis, increased sympathetic activity, as well as altered cellular ion channel activities 10 . Hypertension contributes to AF through hypertrophy of cardiac myocytes, proliferation of fibrous tissue, and decreased intercellular coupling and increases risk in large populations by 3‐ to 4‐fold 11,12 . Advanced age contributes to the pathogenesis of AF through increased infiltration of fatty tissue in the left atrial endothelium as well as increased collagen and atrial amyloid deposition 13,14 .…”

Defective peroxisomal proliferators activated receptor gamma activity due to dominant‐negative mutation synergizes with hypertension to accelerate cardiac fibrosis in mice

“…Hypertensive heart disease and cardiac hypertrophy, often associated with insulin resistance, are leading causes of high morbidity and mortality due to the predisposition to the development of congestive cardiac failure and sudden death. During this process, remodelling of the heart takes place contributing to persistent contractile dysfunction and in numerous cases to arrhythmia . Although the precise mechanisms underlying cardiac remodelling remain under intensive investigation, the involvement of increased activity of the renin–angiotensin–aldosterone system is well recognised—as indicated by experimental models of aldosterone or AngII‐induced hypertension where a similar process of remodelling occurs …”

“…During this process, remodelling of the heart takes place contributing to persistent contractile dysfunction 6 and in numerous cases to arrhythmia. 7 Although the precise mechanisms underlying cardiac remodelling remain under intensive investigation, the involvement of increased activity of the renin-angiotensin -aldosterone system is well recognised 7 -as indicated by experimental models of aldosterone or AngII-induced hypertension where a similar process of remodelling occurs. 8 Despite its low abundance in the heart, a direct role of PPARg in cardiac hypertrophy has been hypothesised previously.…”

Editorial [Hot Topic: The Clinical Management and Treatment of Hypertension, Its Pathophysiology and the Clinical Use of Antihypertensive Drugs (Executive Editor: Gregory Y.H. Lip)]

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This issue of Current Pharmaceutical Design, for which I have the honour to be Executive Guest Editor, addresses issues relating to the clinical management and treatment of hypertension, its pathophysiology and the clinical use of antihypertensive drugs.Goon et al[1] discuss hypertension, anti-hypertensive therapy and neoplasia, providing an overview establishing the strengths and weaknesses of the arguments presented and highlighting possible pharmacophysiological pathways involved.Aidietis et al [2] then address the role of hypertension in the pathogenesis of cardiac arrhythmias.Kuhl et al [3] then address the important issue of the management of hypertension in relation to acute coronary syndromes and revascularisation. Their review discusses the frequency of hypertension and acute coronary syndromes as single clinical conditions, as well as their combined presentations, which necessitates a pragmatic management approach.

Karthikeyan and Lip [4] then address the area of hypertension in pregnancy, where information on pathophysiology is everexpanding, as well as new insights into management strategies.

Finally, we end on a more controversial note, where Lim and Lip [5] provide a viewpoint on metabolic syndrome and the continuum with diabetes.

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“…Aidietis et al [2] then address the role of hypertension in the pathogenesis of cardiac arrhythmias.…”