Atrial Fibrillation in Patients With Hypertension
Trajectories of Risk Factors in Yet Another Manifestation of Hypertensive Target Organ Damage
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See related article, pp 597–605
Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia, with an increasing prevalence and incidence with age and associated cardiovascular comorbidities.1 The prevalence and incidence of hypertension also increases with increasing age, and hypertension is the commonest pathogenic risk factor for the development of AF. The development of AF is most evident in the presence of hypertensive left ventricular hypertrophy, especially where there is associated heart failure with preserved ejection fraction.
Not only does hypertension increase the risk of incident AF but also both conditions commonly coexist in the same patient.1 Both conditions individually lead to complications, such as stroke and heart failure, with the risks accentuated when both the disorders are present. Other epidemiological links are also evident, with the intimate relationship of AF and hypertension individually to coronary artery disease (especially myocardial infarction), obesity, and obstructive sleep apnea and to alcohol excess. Associated renal dysfunction or proteinuria (commonly seen in association with hypertension) can predispose to the development of AF.1 Uncontrolled hypertension leads to more strokes, whether in AF or non-AF patients. When anticoagulants are used, uncontrolled blood pressure increases the risk of serious bleeding.2
Underlying these epidemiological relationships are the pathophysiological similarities.1 AF confers a prothrombotic or hypercoagulable state, leading to the higher risk of thromboembolism.3 A prothrombotic state is also seen with hypertension, given the observation that despite the blood vessels being exposed …