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Atrial fibrillation in essential hypertension: an issue of concern

Li-Qun Zhao1, Shao-Wen Liu

  • 1Shanghai Jiao Tong University affiliated first people's Hospital, Shanghai, China.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|February 21, 2014
PubMed

Insights

Essential hypertension contributes to atrial fibrillation through progressive atrial remodeling. Understanding these changes offers therapeutic windows, potentially through non-antiarrhythmic drugs, to prevent and manage this common arrhythmia.

Area of Science:

  • Cardiology
  • Clinical Electrophysiology
  • Pharmacology

Background:

  • Atrial fibrillation (AF) is strongly linked to hypertension, affecting both blood pressure (BP) levels and circadian BP rhythms.
  • The precise mechanisms linking essential hypertension to AF, particularly atrial remodeling, require further elucidation.
  • Hypertension-induced atrial changes are progressive, creating potential windows for intervention before irreversible remodeling occurs.

Purpose of the Study:

  • To review the multifaceted relationship between essential hypertension and atrial fibrillation.
  • To explore the underlying mechanisms of AF in hypertensive patients, focusing on atrial remodeling.
  • To identify potential therapeutic strategies beyond traditional antiarrhythmic drugs.

Main Methods:

  • Review of clinical studies and existing literature on hypertension and atrial fibrillation.
  • Analysis of the pathophysiological processes involved in hypertension-induced atrial remodeling.
  • Evaluation of current and emerging therapeutic approaches, including non-antiarrhythmic drugs.

Main Results:

  • Hypertension promotes AF through mechanisms like myocyte repolarization changes and progressive atrial remodeling (structural and electrical).
  • These remodeling processes occur over time, indicating critical periods for intervention.
  • While angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) show promise, their benefit in AF is currently limited to hypertensive patients with specific cardiac conditions.

Conclusions:

  • Effective prevention and management of AF in essential hypertension necessitate a deeper understanding of progressive atrial remodeling.
  • Exploring non-antiarrhythmic drugs targeting atrial remodeling represents a promising new therapeutic avenue.
  • Targeted therapies, potentially including ACEIs and ARBs in specific patient subgroups, are crucial for managing AF in the context of hypertension.

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