Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive Patients
Because of demographic aging, the prevalence of arterial hypertension (HTN) and cardiac arrhythmias, namely atrial fibrillation (AF), is progressively increasing. Not only are these clinical entities strongly connected, but, acting with a synergistic effect, their association may cause a worse clini...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-04-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/9/4/110 |
| _version_ | 1797445719708139520 |
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| author | Jacopo Marazzato Federico Blasi Michele Golino Paolo Verdecchia Fabio Angeli Roberto De Ponti |
| author_facet | Jacopo Marazzato Federico Blasi Michele Golino Paolo Verdecchia Fabio Angeli Roberto De Ponti |
| author_sort | Jacopo Marazzato |
| collection | DOAJ |
| description | Because of demographic aging, the prevalence of arterial hypertension (HTN) and cardiac arrhythmias, namely atrial fibrillation (AF), is progressively increasing. Not only are these clinical entities strongly connected, but, acting with a synergistic effect, their association may cause a worse clinical outcome in patients already at risk of ischemic and/or haemorrhagic stroke and, consequently, disability and death. Despite the well-known association between HTN and AF, several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. Although several trials reported the overall clinical benefit of renin–angiotensin–aldosterone inhibitors in reducing incident AF in HTN, the role of this class of drugs is greatly reduced when AF diagnosis is already established, thus hinting at the urgent need for primary prevention measures to reduce AF occurrence in these patients. Through a thorough review of the available literature in the field, we investigated the basic mechanisms through which HTN is believed to promote AF, summarising the evidence supporting a pathophysiology-driven approach to prevent this arrhythmia in hypertensive patients, including those suffering from primary aldosteronism, a non-negligible and under-recognised cause of secondary HTN. Finally, in the hazy scenario of AF screening in hypertensive patients, we reviewed which patients should be screened, by which modality, and who should be offered oral anticoagulation for stroke prevention. |
| first_indexed | 2024-03-09T13:29:53Z |
| format | Article |
| id | doaj.art-1bea685892aa4054a494b056e5b44295 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-09T13:29:53Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-1bea685892aa4054a494b056e5b442952023-11-30T21:18:27ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252022-04-019411010.3390/jcdd9040110Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive PatientsJacopo Marazzato0Federico Blasi1Michele Golino2Paolo Verdecchia3Fabio Angeli4Roberto De Ponti5Department of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyDepartment of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyDepartment of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyFondazione Umbra Cuore e Ipertensione-ONLUS, 06100 Perugia, ItalyDepartment of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyDepartment of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyBecause of demographic aging, the prevalence of arterial hypertension (HTN) and cardiac arrhythmias, namely atrial fibrillation (AF), is progressively increasing. Not only are these clinical entities strongly connected, but, acting with a synergistic effect, their association may cause a worse clinical outcome in patients already at risk of ischemic and/or haemorrhagic stroke and, consequently, disability and death. Despite the well-known association between HTN and AF, several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. Although several trials reported the overall clinical benefit of renin–angiotensin–aldosterone inhibitors in reducing incident AF in HTN, the role of this class of drugs is greatly reduced when AF diagnosis is already established, thus hinting at the urgent need for primary prevention measures to reduce AF occurrence in these patients. Through a thorough review of the available literature in the field, we investigated the basic mechanisms through which HTN is believed to promote AF, summarising the evidence supporting a pathophysiology-driven approach to prevent this arrhythmia in hypertensive patients, including those suffering from primary aldosteronism, a non-negligible and under-recognised cause of secondary HTN. Finally, in the hazy scenario of AF screening in hypertensive patients, we reviewed which patients should be screened, by which modality, and who should be offered oral anticoagulation for stroke prevention.https://www.mdpi.com/2308-3425/9/4/110hypertensionatrial fibrillationprimary hyperaldosteronismantihypertensive agentsartificial pacemakersanticoagulants |
| spellingShingle | Jacopo Marazzato Federico Blasi Michele Golino Paolo Verdecchia Fabio Angeli Roberto De Ponti Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive Patients Journal of Cardiovascular Development and Disease hypertension atrial fibrillation primary hyperaldosteronism antihypertensive agents artificial pacemakers anticoagulants |
| title | Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive Patients |
| title_full | Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive Patients |
| title_fullStr | Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive Patients |
| title_full_unstemmed | Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive Patients |
| title_short | Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive Patients |
| title_sort | hypertension and arrhythmias a clinical overview of the pathophysiology driven management of cardiac arrhythmias in hypertensive patients |
| topic | hypertension atrial fibrillation primary hyperaldosteronism antihypertensive agents artificial pacemakers anticoagulants |
| url | https://www.mdpi.com/2308-3425/9/4/110 |
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