Hypertension and atrial fibrillation: epidemiology, pathophysiology and therapeutic implications

Abstract

Hypertension is one of the most important risk factors associated with atrial fibrillation (AF) and increased the risk of cardiovascular events in patients with AF. However, the pathophysiological link between hypertension and AF is unclear. Nevertheless, this can be explained by the hemodynamic changes of the left atrium secondary to long standing hypertension, resulting in elevated left atrium pressure and subsequently left atrial enlargement. Moreover, the activation of renin --angiotensin --aldosterone system (RAAS) activation in patients with hypertension induces left atrial fibrosis and conduction block in the left atrium, resulting in the development of AF. Accordingly, recent studies have shown that effective blockage of RAAS by angiotensin converting enzyme inhibitors or angiotensin receptor antagonist may be effective in both primary and secondary prevention of AF in patients with hypertension, although with controversies. In addition, optimal antithrombotic therapy, blood pressure control as well as rate control for AF are key to the management of patients with AF. 1,2 Both hypertension 3 and AF 4 have increased frequency with the ageing population worldwide, and are associated with increased cardiovascular events. They are important risk factors for stroke, heart failure and overall mortality. 5 --7 On the other hand, hypertension is one of the important risk factors for the occurrence of AF, 8 and increased the risk of stroke and cardiovascular mortality in patients with AF.9,10 Compare with other risk factors for AF, hypertension appears to be responsible for more AF than any other risk factor because of its high prevalence. However, the pathophysiological link between AF and hypertension remains unclear. Moreover, it is also unclear whether treatment of hypertension prevents AF or reduces the risk of AF related complications. The purpose of this article is to review the epidemiology, underlying mechanisms and therapeutic implications of AF in hypertensive patients. A systematic literature search for full-text papers in the English language was performed using MEDLINE, Embase and the Cochrane library through to July 2011. In the search phrases used, the following terms were used: 'atrial fibrillation', 'hypertension', 'epidemiology', 'pathophysiology' and 'treatment'. Papers selected and cited in this review were based on the authors' view on the relevance to the manuscript. In addition, abstracts from international cardiovascular meetings were studied to identify unpublished studies.

Telmisartan reduces atrial arrhythmia susceptibility through the regulation of RAS–ERK and PI3K–Akt–eNOS pathways in spontaneously hypertensive rats

“…Previous work has shown that RAS activation in patients with hypertension induces left atrial fibrosis and blocks conduction in the left atrium, resulting in the development of AF (Lau et al 2012). Indeed, left atrial enlargement, atrial fibrosis, and cardiac myocyte apoptosis was observed in the atria of SHR rats in this study.…”

Roles of the CHADS2 and CHA2DS2-VASc scores in post-myocardial infarction patients: Risk of new occurrence of atrial fibrillation and ischemic stroke

“…Consistent with these studies, most traditional risk factors such as increasing age, diabetes mellitus, congestive heart failure, and prior stroke have been demonstrated to be associated with new AF in the present cohort of post-MI patients. Nonetheless, in our cohort, hypertension, one of the strongest risk factors of AF [9], did not appear to contribute to the subsequent development of AF. In stark contrast to previous community studies [26], female gender instead of male gender was shown to be associated with new AF in our cohort.…”

“…The individual score components not only predict ischemic stroke risk associated with AF, but have also been linked to the development of AF [5,6,9]. In this study, we sought to investigate whether the CHADS 2 and CHA 2 DS 2 -VASc scores can predict new-onset AF and ischemic stroke in patients with MI but no previously documented AF.…”

Effect of Telmisartan on Atrial Fibrillation Recurrences in Patients with Hypertension: A Systematic Review and Meta‐Analysis

“…Hypertension was associated with AF by its effect on atrial remodeling, which contribute to AF development and recurrences [10][11][12][13][14][15][16]. In theory, all effective antihypertensive drugs could reduce the risk of AF nearly by reversing structural cardiac damage caused by hypertension [17,18].…”