Invited review: hypertension and atrial fibrillation: epidemiology, pathophysiology, and implications for management

Jakub Gumprecht, Magdalena Domek, Gregory Y H Lip, Alena Shantsila*

*Kontaktforfatter

Publikation: Bidrag til tidsskriftReview (oversigtsartikel)peer review

52 Citationer (Scopus)

Abstract

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.

OriginalsprogEngelsk
TidsskriftJournal of Human Hypertension
Vol/bind33
Udgave nummer12
Sider (fra-til)824-836
Antal sider13
ISSN0950-9240
DOI
StatusUdgivet - dec. 2019

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