[Frontiers In Bioscience, Scholar, 10, 276-284, March 1, 2018]

Hypertension and atrial fibrillation: a bench to bedside perspective

Emmanuel A. Andreadis1, Charalampia V. Geladari1

1Fourth Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece


1. Abstract
2. Hypertension and atrial fibrillation: the rising prevalence of the two cardiovascular “epidemics”
3. Hypertensive heart disease leads to left ventricular hypertrophy and heart failure generating an arrhythmogenic myocardial substrate
4. Atrial structural and electrical remodeling are the hallmarks of atrial fibrillation
5. Animal models
6. Risk stratification in hypertensives with atrial fibrillation
7. Use of antihypertensive medication in patients with atrial fibrillation
8. Summary
9. References


Atrial Fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and its prevalence increases markedly with advancing age, worldwide. Almost every primary care physician, internist, or cardiologist, has dealt with stroke or with other complications of AF. Still, its management remains a hot issue for clinicians and the debate over which treatment strategy is the best is ongoing. Moreover, AF increases significantly the total cardiovascular (CV) morbidity and mortality. Despite a great bulk of data in the existing medical literature, the pathophysiology of AF in patients with hypertensive heart disease (HHD) is poorly understood, and the underlying signaling pathways linking hypertension (HTN) to AF remain to be fully elucidated. The scope of this article is to discuss the myocardial anatomical and physiological alterations that occur in HTN, and highlight the proposed electrophysiological mechanisms that cause the hypertensive heart to fibrillate. In addition, we will focus on the latest ESC 2016 guidelines for the risk stratification of AF patients as a tool to guide anticoagulation which represents the mainstay of treatment for AF. Last, the other therapeutic approaches for hypertensives with AF currently adopted for optimal patient management will be reviewed.


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Abbreviations; AF, atrial fibrillation, BP, blood pressure, CDC, Centers for Disease Control and Prevention, CV, cardiovascular, GJ, gap junction, Cx, connexin, HF, heart failure, HHD, hypertensive heart disease, HTN, hypertension, ID, intercalated disc, IHD, ischemic heart disease, LTCC, long type calcium channel, LV, left ventricle, LVH, left ventricular hypertrophy, NFAT, nuclear factor of activated T cells, NOAC, new oral anticoagulant, OAC, oral anticoagulation, RAAS, renin angiotensin aldosterone system, RWT, relative wall thickness, SCD, sudden cardiac death, SNS, sympathetic nervous system

Key Words: Atrial Fibrillation, Hypertension, Left Ventricular Hypertrophy, Signaling Pathways, Atrial Enlargement, Myocardial Remodeling, Intercalated Disc Remodeling, Stroke, Risk Stratification, Anticoagulation, Rate Control, Rhythm Control, Invasive Therapies, Review

Send correspondence to: Emmanuel A. Andreadis, 7 Dimocharous Street, Kolonaki, Athens, Greece, 11521, Tel: 302107224258, Fax: 302132041606, E-mail: andreadise@usa.net