Invited review: hypertension and atrial fibrillation: epidemiology, pathophysiology, and implications for management.
Jakub GumprechtMagdalena DomekGregory Yoke Hong LipAlena ShantsilaPublished in: Journal of human hypertension (2019)
Hypertension affects around half of the adult population worldwide, being one of the most common cardiovascular disorders. On a population basis, high blood pressure is considered to be the major independent risk factor for atrial fibrillation (AF). The incidence of both diseases has increased significantly in the recent decades and it is expected to continuously surge in the following years. Due to close relation between the both diseases and their frequent coexistence, hypertension and AF become major health priorities. The multidirectional linking between raised blood pressure and AF is based on complex associations including structural, hemodynamic, neuroendocrine, and autonomic mechanisms. Hypertension provokes excessive fibroblasts proliferation and increased collagen accumulation. It also stimulates cardiomyocytes apoptosis and inflammation, leading to diffused fibrosis and left ventricular hypertrophy development. This is mainly driven by renin-angiotensin-aldosterone system (RAAS) activation, and autonomic dysregulation. Moreover, exposure on long-term stretch due to hypertension causes arterial stiffness with subsequent systolic and diastolic function loss resulting in further heart muscle remodeling. All these pathological changes combined seem influence on myocardial electrical activity, triggering AF development. Given the prevalence and frequent lack of symptoms of both disorders, opportunistic arrhythmia screening in hypertensive patients is needed. In all individuals with established diagnosis of AF, adequate anticoagulation has to be considered for stroke prevention. Blood pressure control is also an essential component of a holistic approach to AF care.
Keyphrases
- blood pressure
- atrial fibrillation
- hypertensive patients
- heart rate
- catheter ablation
- left atrial
- oral anticoagulants
- left ventricular
- heart failure
- left atrial appendage
- direct oral anticoagulants
- healthcare
- oxidative stress
- percutaneous coronary intervention
- risk factors
- heart rate variability
- angiotensin ii
- type diabetes
- public health
- blood glucose
- endoplasmic reticulum stress
- mental health
- palliative care
- cell death
- hypertrophic cardiomyopathy
- weight loss
- blood brain barrier
- pain management
- subarachnoid hemorrhage
- chronic pain
- metabolic syndrome
- acute myocardial infarction
- skeletal muscle
- sleep quality
- pi k akt
- health insurance