Hypertension and Atrial Fibrillation: An Intimate Association of Epidemiology, Pathophysiology, and Outcomes
Abstract
Atrial fibrillation (AF) is the most prevalent sustained arrhythmia found in clinical practice. AF rarely exists as a single entity but rather as part of a diverse clinical spectrum of cardiovascular diseases, related to structural and electrical remodeling within the left atrium, leading to AF onset, perpetuation, and progression. Due to the high overall prevalence within the AF population arterial hypertension plays a significant role in the pathogenesis of AF and its complications. Fibroblast proliferation, apoptosis of cardiomyocytes, gap junction remodeling, accumulation of collagen both in atrial and ventricular myocardium all accompany ageing-related structural remodeling with impact on electrical activity. The presence of hypertension also stimulates oxidative stress, systemic inflammation, rennin–angiotensin–aldosterone and sympathetic activation, which further drives the remodeling process in AF. Importantly, both hypertension and AF independently increase the risk of cardiovascular and cerebrovascular events, e.g., stroke and myocardial infarction. Given that both AF and hypertension often present with limited on patient wellbeing, treatment may be delayed resulting in development of complications as the first clinical manifestation of the disease. Antithrombotic prevention in AF combined with strict blood pressure control is of primary importance, since stroke risk and bleeding risk are both greater with underlying hypertension.
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- Authors
- Dzeshka, M. S., Shahid, F., Shantsila, A., & Lip, G. Y. H.
- Affiliations
- Birmingham City Hospital (GB)
- Venue
- American Journal of Hypertension
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-02-18
- Volume
- 30
- Issue
- 8
- Pages
- 733-755
- ISSN
- 0895-7061 (ISSN-L)
- 1941-7225
- OpenAlex
- W2590424075
- Cited by
- 91
- References
- 157
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 8 · 2023: 13 · 2022: 10 · 2021: 11 · 2020: 15 · 2019: 10 · 2018: 5 · 2017: 5
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- atrial fibrillation, hypertension, atrial remodeling, left atrium, fibroblast proliferation, cardiomyocyte apoptosis, gap junction remodeling, collagen deposition, oxidative stress, systemic inflammation, renin-angiotensin-aldosterone system, sympathetic activation, stroke risk, myocardial infarction, antithrombotic therapy, blood pressure control, bleeding risk
- MeSH terms
- Atrial Fibrillation, Humans, Hypertension, Prognosis, Treatment Outcome, Atrial Remodeling
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