A review of hypertension management in atrial fibrillation

Sidakpal S. Panaich, Nilay Patel, Kanishk Agnihotri, Shilpkumar Arora, Chirag Savani, Nileshkumar J. Patel, Samir V. Patel, Rajesh Sonani, Achint Patel, Sopan Lahewala, Vikas Singh, Badal Thakkar, Parth Bhatt, Abhishek Deshmukh, Apurva O. Badheka

Research output: Contribution to journalReview articlepeer-review

Abstract

Atrial fibrillation (AF) is one of the commonest arrhythmias in clinical practice and has major healthcare and economic implications. It is a growing epidemic with prevalence all set to double to 12 million by 2050. After adjusting for other associated conditions, hypertension confers a 1.5- and 1.4-fold risk of developing AF, for men and women respectively. Furthermore, in patients with AF, the presence of hypertension has a cumulative effect on the risk of stroke. Growing evidence suggests reversal or attenuation of various structural and functional changes predisposing to AF with the use of antihypertensive medications. Randomized trials have shown major reduction in the risk of stroke and heart failure with blood pressure reduction. However, such trials are lacking in AF patients specifically. The Joint National Committee-8 guidelines have not addressed the threshold or goal BP for patients with known AF. Furthermore, “J-shaped” or “U-shaped” curves have been noted during hypertension management in patients with AF with published data demonstrating worse outcomes in patients with strict BP control to <110/60 mmhg similar to coronary artery disease. In this review, we outline the available literature on management of hypertension in patients with AF as well as the role of individual anti-hypertensive medications in reducing the incidence of AF Fig. 1.

Original languageEnglish (US)
Pages (from-to)196-202
Number of pages7
JournalCurrent Hypertension Reviews
Volume12
Issue number3
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Keywords

  • ACE Inhibitors/ARBs
  • Antihypertensive medications
  • Atrial Fibrillation
  • Beta blockers
  • Diuretics
  • Hypertension
  • Management

ASJC Scopus subject areas

  • Internal Medicine

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