Arterial Hypertension

Arterial hypertension (AH) is defined as repeatedly measured blood pressure >140/90 mmHg.

Uncontrolled arterial hypertension (AH) increases the incidence and worsens the clinical course of atrial fibrillation (AF).

In AH, left ventricular hypertrophy and impaired relaxation develop, resulting in diastolic dysfunction. Subsequently, left atrial pressure increases, leading to left atrial dilatation and fibrosis. Atrial remodelling occurs. AH creates a substrate for AF and worsens AF through three main mechanisms:

Increases pressure and enlarges the volume of the left atrium
Causes inflammation and fibrosis in the left atrium
Shortens the atrial refractory period

Uncontrolled AH, regardless of the presence of AF, increases the risk of:

Stroke
Heart failure
Bleeding
Cardiovascular mortality

Illustration depicting the relationship between arterial hypertension and atrial fibrillation with an ECG recording of the arrhythmia.

Arterial Hypertension
Definition Arterial hypertension (AH) is defined as repeatedly measured blood pressure >140/90 mmHg.
Symptoms Headache Dizziness Fatigue Angina (chest pressure) Epistaxis (nosebleed) Tinnitus (ringing in the ears)
Diagnosis The patient measures blood pressure once daily (at home, seated and at rest). This measurement is repeated for 5 consecutive days. If the average of these five measurements is >140/90 mmHg, the patient has AH.

The treatment strategy for AH is a target blood pressure of 120–129/70–79 mmHg,

the specific combination of antihypertensive agents used to achieve this target is not essential.

Elderly patients (>70 years) may benefit from a higher systolic blood pressure of 130–150 mmHg in order to:

eliminate the risk of falls due to orthostatic hypotension
maintain adequate perfusion of critical organs: brain, kidneys, heart
preserve cerebral perfusion and cognitive function as much as possible

ACE inhibitors and angiotensin receptor blockers are among the antihypertensive agents that most effectively reduce the incidence and improve the course of AF.

Therefore, these antihypertensive agents are preferred in patients with AF and AH.

Each reduction of systolic blood pressure by 5 mmHg reduces the risk of a cardiovascular event by 9%. Cardiovascular events include:

Unstable angina pectoris
Myocardial infarction
Acute heart failure
Stroke
Sudden cardiac death
Aborted cardiac death

Arterial Hypertension and Atrial Fibrillation	Class
Adequate treatment of arterial hypertension (<140/90 mmHg) reduces the incidence and improves the clinical course of AF and reduces the risk of cardiovascular events.	I
The treatment strategy for arterial hypertension is a target blood pressure of 120–129/70–79 mmHg, regardless of the combination of antihypertensive agents used to achieve this target.	I
ACE inhibitors and angiotensin receptor blockers are the preferred antihypertensive agents in patients with atrial fibrillation.	IIa