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Review
. 2015 Oct-Dec;11(4):228-34.
doi: 10.14797/mdcj-11-4-228.

Atrial Fibrillation and Hypertension: Mechanistic, Epidemiologic, and Treatment Parallels

Adedotun A Ogunsua  1 , Amir Y Shaikh  1 , Mohamed Ahmed  1 , David D McManus  1
Affiliations
Review

Atrial Fibrillation and Hypertension: Mechanistic, Epidemiologic, and Treatment Parallels

Adedotun A Ogunsua et al. Methodist Debakey Cardiovasc J. 2015 Oct-Dec.

Abstract

Atrial fibrillation (AF) is an increasingly prevalent condition and the most common sustained arrhythmia encountered in ambulatory and hospital practice. Several clinical risk factors for AF include age, sex, valvular heart disease, obesity, sleep apnea, heart failure, and hypertension (HTN). Of all the risk factors, HTN is the most commonly encountered condition in patients with incident AF. Hypertension is associated with a 1.8-fold increase in the risk of developing new-onset AF and a 1.5-fold increase in the risk of progression to permanent AF. Hypertension predisposes to cardiac structural changes that influence the development of AF such as atrial remodeling. The renin angiotensin aldosterone system has been demonstrated to be a common mechanistic link in the pathogenesis of HTN and AF. Importantly, HTN is one of the few modifiable AF risk factors, and guideline-directed management of HTN may reduce the incidence of AF.

Keywords: ACE inhibitors; RAAS pathway; arrhythmias; benign essential hypertension; nonvalvular atrial fibrillation.

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Figures

None
A. A. Ogunsua, M.D., M.P.H.
Figure 1.
Figure 1.
Prevalence of hypertension in atrial fibrillation trials. AF: atrial fibrillation. Adapted with permission from Manolis et al. J Hypertens; 2012;30:239–52.
Figure 2.
Figure 2.
Mechanisms of atrial fibrillation. AF: atrial fibrillation; Ca++: ionized calcium; RAAS: renin-angiotensin-aldosterone system. Adapted with permission from January et al. J Am Coll Cardiol; 2014;64:2305–7.
See this image and copyright information in PMC

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