Better blood pressure control in patients with atrial fibrillation: overcoming barriers to improve outcomes

Hypertension is the single most important risk factor for development of atrial fibrillation (AF), which may be considered as a cardiac manifestation of hypertensive target organ damage. Furthermore, coexistence of hypertension and AF mutually amplifies the risk of complications, such as heart failure and stroke.1 Hypertension results in structural changes in the heart, facilitated by the haemodynamic disturbances, autonomic dysregulation, atrial myocardial cellular injury with apoptosis and activation of profibrotic signalling pathways. These structural changes occur and progress as a result of prolonged exposure to risk factors with more electrical heterogeneity across the atria and arrhythmogenic substrate in patients with longer hypertension history and poor blood pressure (BP) control. Once AF is initiated, the arrhythmia itself can further stimulate above pathways, creating a vicious cycle that allows arrhythmia perpetuation and progression from paroxysmal to non-paroxysmal types.1 By preventing or reversing the adverse cardiac remodelling processes...
Source: Heart - Category: Cardiology Authors: Tags: Editorials Source Type: research