Atrial Fibrillation and Hypertension: “Quo Vadis”

Abstract: Hypertension is one of the most well-established risk factors for atrial fibrillation. Long-standing untreated hypertension leads to structural remodeling and electrophysiologic alterations causing an atrial myopathy that forms a vulnerable substrate for the development and maintenance of atrial fibrillation. Hypertension-induced hemodynamic, inflammatory, hormonal, and autonomic changes all appear to be important contributing factors. Furthermore, hypertension is also associated with several atrial fibrillation-related comorbidities. As such, hypertension may represent an important target for therapy in atrial fibrillation. Clinicians should be aware of pitfalls of the blood pressure measurement in atrial fibrillation. While the auscultatory method is preferred, the use of automated devices appears to be an acceptable method in the ambulatory setting. There are pathophysiologic bases and emerging clinical evidence suggesting the benefit of renin-angiotensin system inhibition in risk reduction of atrial fibrillation development particularly in patients with left ventricular hypertrophy or left ventricular dysfunction. A better understanding of hypertension’s pathophysiologic link to atrial fibrillation may lead to the development of novel therapies for the primary prevention of atrial fibrillation. Finally, future studies are needed to address optimal blood pressure goal to minimize the risk of atrial fibrillation-related complications.

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Atrial Fibrillation and Hypertension: "Quo Vadis"

Current Hypertension Reviews ◽

10.2174/1573402115666190502142824 ◽

2019 ◽

Vol 15 ◽

Author(s):

McCall Walker ◽

Paras Patel ◽

Osung Kwon ◽

Ryan J Koene ◽

Daniel A. Duprez ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Blood Pressure Measurement ◽

Renin Angiotensin System ◽

Left Ventricular ◽

Ambulatory Setting ◽

Blood Pressure Goal ◽

Contributing Factors ◽

Acceptable Method ◽

Quo Vadis

: Hypertension is one of the most well-established risk factors for atrial fibrillation. Long-standing untreated hypertension leads to structural remodeling and electrophysiologic alterations causing an atrial myopathy that forms a vulnerable substrate for the development and maintenance of atrial fibrillation. Hypertension-induced hemodynamic, inflammatory, hormonal, and autonomic changes all appear to be important contributing factors. Furthermore, hypertension is also associated with several atrial fibrillation-related comorbidities. As such, hypertension may represent an important target for therapy in atrial fibrillation. Clinicians should be aware of pitfalls of the blood pressure measurement in atrial fibrillation. While the auscultatory method is preferred, the use of automated devices appears to be an acceptable method in the ambulatory setting. There are pathophysiologic bases and emerging clinical evidence suggesting the benefit of renin-angiotensin system inhibition in risk reduction of atrial fibrillation development particularly in patients with left ventricular hypertrophy or left ventricular dysfunction. A better understanding of hypertension’s pathophysiologic link to atrial fibrillation may lead to the development of novel therapies for the primary prevention of atrial fibrillation. Finally, future studies are needed to address optimal blood pressure goal to minimize the risk of atrial fibrillation-related complications.

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Beat-to-beat blood pressure measurement in patients with atrial fibrillation: a step towards personalized managemen

Jounal of arrhythmology ◽

10.35336/va-2021-1-23-32 ◽

2021 ◽

Vol 28 (1) ◽

pp. 23-32

Author(s):

V. V. Shubik ◽

V. V. Pivovarov ◽

G. K. Zaytsev ◽

A. B. Korneev ◽

V. M. Tihonenko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Blood Pressure Measurement ◽

Left Ventricular ◽

Heart Beat ◽

Left Ventricular Ejection ◽

Main Diagnosis ◽

Measurement Variability ◽

Ventricular Ejection Fraction ◽

Minute Interval

Aim. Blood pressure (BP) determination in atrial fibrillation (AF) patients remains challenging due to its high inter-measurement variability. The novel methodology of precise beat-to-beat BP determination may be used to guide the hypotensive therapy selection and adjustment, but along with that provides additional opportunity for the investigation of hemodynamics in patients with chronic AF.Material and method. The study sample consisted of 60 patients with the main diagnosis of grade II-III arterial hypertension; 30 of those were on sinus rhythm and 30 had chronic non-valvular AF. In all patients HR was within the limits recommended for left ventricular ejection fraction of >40%. Beat-to-beat systolic, diastolic, and pulse BP (SBP, DBP, and PBP, respectively) assessment at each heart beat within 15 minute interval was performed with “Kardiotekhnika-SAKR” system (NAO “Incart”, St.Petersburg, Russia).

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HEART COMPLICATIONS IN HYPERTHYROIDISM

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.2.1 ◽

2011 ◽

pp. 7-17

Author(s):

Hai Thuy Nguyen ◽

Anh Vu Nguyen

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Heart Rate ◽

Heart Diseases ◽

Systolic Dysfunction ◽

Oxygen Demand ◽

Left Ventricular ◽

Cardiac Contraction ◽

Cardiac Complications ◽

Cardiac Symptoms

Thyroid hormone increases the force of the contraction and the amount of the heart muscle oxygen demand. It also increases the heart rate. Due to these reasons, the work of the heart is greatly increased in hyperthyroidism. Hyperthyroidism increases the amount of nitric oxide in the intima, lead them to be dilated and become less stiff. Cardiac symptoms can be seen in anybody with hyperthyroidism, but can be particularly dangerous in whom have underlying heart diseases. Common symptoms include: tachycardia and palpitations. Occult hyperthyroidism is a common cause of an increased heart rate at rest and with mild exertion. Hyperthyroidism can also produce a host of other arrhythmias such as PVCs, ventricular tachycardia and especially atrial fibrillation. Left ventricular diastolic dysfunction and systolic dysfunction, Mitral regurgitation and mitral valve prolapsed are heart complications of hyperthyroism could be detected by echocardiography. The forceful cardiac contraction increases the systolic blood pressure despite the increased relaxation in the blood vessels reduces the diastolic blood pressure. Atrial fibrillation, atrial enlargement and congestive heart failure are important cardiac complications of hyperthyroidism. An increased risks of stroke is common in patients with atrial fibrillation. Graves disease is linked to autoimmune complications, such as cardiac valve involvement, pulmonary arterial hypertension and specific cardiomyopathy. Worsening angina: Patients with coronary artery disease often experience a marked worsening in symptoms with hyperthyroidism. These can include an increase in chest pain (angina) or even a heart attack.

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Screening for atrial fibrillation during automated blood pressure measurement among patients admitted to internal medicine ward

Internal and Emergency Medicine ◽

10.1007/s11739-021-02691-2 ◽

2021 ◽

Author(s):

Giacomo Pucci ◽

Edoardo Santoni ◽

Valeria Bisogni ◽

Camilla Calandri ◽

Alberto Cerasari ◽

...

Keyword(s):

Internal Medicine ◽

Atrial Fibrillation ◽

Blood Pressure ◽

Adult Population ◽

Blood Pressure Measurement ◽

University Hospital ◽

Daily Routine ◽

Internal Medicine Ward ◽

Clinical Conditions ◽

Electrocardiogram Ecg

AbstractAtrial fibrillation (AF), the commonest sustained cardiac arrhythmia affecting the adult population, is often casually discovered among hospitalized people. AF onset is indeed triggered by several clinical conditions such as acute inflammatory states, infections, and electrolyte disturbance, frequently occurring during the hospitalization. We aimed to evaluate whether systematic AF screening, performed through an automated oscillometric blood pressure (BP) device (Microlife WatchBP Office AFIB, Microlife AG, Switzerland), is effective for detecting AF episodes in subjects admitted to an Internal Medicine ward. 163 patients consecutively hospitalized at the Unit of Internal Medicine of the “Santa Maria” Terni University Hospital between November 2019 and January 2020 (mean age ± standard deviation: 77 ± 14 years, men proportion: 40%) were examined. Simultaneously with BP measurement and AF screening, a standard 12-lead electrocardiogram (ECG) was performed in all subjects. AF was diagnosed by ECG in 29 patients (18%). AF screening showed overall 86% sensitivity and 96% specificity. False negatives (n = 4) had RR-interval coefficient of variation lower than true positives (n = 25, p < 0.01), suggesting a regular ventricular rhythm during AF. The repeated evaluation substantially confirmed the same level of agreement. AF screening was positive in all patients with new-onset AF (n = 6, 100%). Systematic AF screening in patients admitted to Internal Medicine wards, performed using the Microlife WatchBP Office AFIB, is feasible and effective. The opportunity to implement such technology in daily routine clinical practice to prevent undiagnosed AF episodes in hospitalized patients should be the subject of further research.

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Polymorphisms of the angiotensin-converting enzyme and angiotensinogen gene in patients with atrial fibrillation

Journal of the Renin-Angiotensin-Aldosterone System ◽

10.1177/1470320311399605 ◽

2011 ◽

Vol 12 (4) ◽

pp. 549-556 ◽

Cited By ~ 7

Author(s):

Nurdan Papila Topal ◽

Beste Ozben ◽

Veysel Sabri Hancer ◽

Azra Meryem Tanrikulu ◽

Reyhan Diz-Kucukkaya ◽

...

Keyword(s):

Atrial Fibrillation ◽

Angiotensin Converting Enzyme ◽

Left Atrium ◽

Renin Angiotensin System ◽

Left Ventricular ◽

Converting Enzyme ◽

Angiotensin System ◽

Ras Genes ◽

Angiotensinogen Gene ◽

M235t Polymorphism

Activation of the renin–angiotensin system (RAS) is associated with atrial fibrillation (AF). The aim of this study was to investigate the relation between AF and polymorphisms in RAS. One hundred and fifty patients with AF, 100 patients with no documented episode of AF and 100 healthy subjects were consecutively recruited into the study. The angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism, and the M235T, A-20C, and G-6A polymorphisms of the angiotensinogen gene were genotyped. Patients with AF had significantly lower frequency of II genotype of ACE I/D and higher frequency of angiotensinogen M235T polymorphism T allele and TT genotype and G-6A polymorphism G allele and GG genotype compared with the controls. AF patients had significantly larger left atrium, higher left ventricular mass index (LVMI) and higher frequency of significant valvular pathology. ACE I/D polymorphism II genotype, angiotensinogen M235T polymorphism TT genotype and G allele and GG genotype of angiotensinogen G-6A polymorphism were still independently associated with AF when adjusted for left atrium, LVMI and presence of significant valvular pathology. Genetic predisposition might be underlying the prevalence of acquired AF. Patients with a specific genetic variation in the RAS genes may be more liable to develop AF.

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The relationship between diastolic blood pressure and the risk of cardiovascular events in patients with atrial fibrillation: the Fushimi AF registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1168 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Ikeda ◽

M Iguchi ◽

H Ogawa ◽

Y Aono ◽

K Doi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Diastolic Blood Pressure ◽

Cardiovascular Events ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

The Impact

Abstract Background Hypertension is one of the major risk factors of cardiovascular events in patients with atrial fibrillation (AF). However, relationship between diastolic blood pressure (DBP) and cardiovascular events in AF patients remains unclear. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in Japan. Follow-up data were available in 4,466 patients, and 4,429 patients with available data of DBP were examined. We divided the patients into three groups; G1 (DBP<70 mmHg, n=1,946), G2 (70≤DBP<80, n=1,321) and G3 (80≤DBP, n=1,162), and compared the clinical background and outcomes between groups. Results The proportion of female was grater in G1 group, and the patients in G1 group were older and had higher prevalence of heart failure (HF), diabetes mellitus (DM), chronic kidney disease (CKD). Prescription of beta blockers was higher in G1 group, but that of renin-angiotensin system-inhibitors and calcium channel blocker was comparable. During the median follow-up of 1,589 days, in Kaplan-Meier analysis, the incidence rates of cardiovascular events (composite of cardiac death, ischemic stroke and systemic embolism, major bleeding and HF hospitalization during follow up) were higher in G1 group and G3 group than G2 group (Figure 1). When we divided the patients based on the systolic blood pressure (SBP) at baseline (≥130 mmHg or <130 mmHg), the incidence of rates of cardiovascular events were comparable among groups. Multivariate Cox proportional hazards regression analysis including female gender, age (≥75 years), higher SBP (≥130 mmHg), DM, pre-existing HF, CKD, low left ventricular ejection fraction (<40%) and DBP (G1, G2, G3) revealed that DBP was an independent determinant of cardiovascular events (G1 group vs. G2 group; hazard ratio (HR): 1.40, 95% confidence intervals (CI): 1.19–1.64, G3 group vs. G2 group; HR: 1.23, 95% CI: 1.01–1.49). When we examined the impact of DBP according to 10 mmHg increment, patients with very low DBP (<60 mmHg) (HR: 1.50,95% CI:1.24–1.80) and very high DBP (≥90 mmHg) (HR: 1.51,95% CI:1.15–1.98) had higher incidence of cardiovascular events than patients with DBP of 70–79 mmHg (Figure 2). However, when we examined the impact of SBP according to 20 mmHg increment, SBP at baseline was not associated with the incidence of cardiovascular events (Figure 3). Conclusion In Japanese patients with AF, DBP exhibited J curve association with higher incidence of cardiovascular events. Funding Acknowledgement Type of funding source: None

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