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Gawałko M, Linz D. Atrial Fibrillation Detection and Management in Hypertension. Hypertension 2023; 80:523-533. [PMID: 36519436 DOI: 10.1161/hypertensionaha.122.19459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hypertension is prevalent in >70% of atrial fibrillation patients. In turn, hypertensive patients have up to 73% greater likelihood of atrial fibrillation. Current guidelines recommend that a systematic atrial fibrillation screening may be justified in all patients aged ≥65 years with at least 1 cardiovascular disease, including hypertension. Although most blood pressure monitors include algorithms to detect atrial fibrillation with a high sensitivity of 96 [92-98]% and specificity of 94 [91-96]%, an electrocardiography confirmation is necessary to establish a diagnosis of atrial fibrillation. Early detection and diagnosis of atrial fibrillation is important to allow initiation of atrial fibrillation management. In the Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST-AFNET 4), hypertension was present in 88% of participants, and early rhythm control therapy lowered the risk of adverse cardiovascular outcomes in patients with early atrial fibrillation aged >75 or with CHA2DS2-VASc score ≥2 (Congestive heart failure, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65-74, Sex category [female]) and cardiovascular condition. Strategies for early atrial fibrillation detection should always be linked to a comprehensive atrial fibrillation work-up infrastructure organized within an integrated ABC pathway (Anticoagulation/Avoid stroke; Better symptom control; Cardiovascular and Comorbidity optimization). For secondary prophylaxis, blood pressure control should be embedded in a combined risk factor management program. In hypertensive patients where no atrial fibrillation is detected, intensive blood pressure lowering therapy for primary prophylaxis should be initiated to reduce the risk of developing atrial fibrillation and other cardiovascular complications in the future. The aim of the article is to review the current literature on atrial fibrillation detection and management in hypertensive patients.
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Affiliation(s)
- Monika Gawałko
- First Department of Cardiology, Medical University of Warsaw, Poland (M.G.).,Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.G., D.L.)
| | - Dominik Linz
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (D.L.).,Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Australia (D.L.).,Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands (D.L.)
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Abstract
Hypertension is the most prevalent cardiovascular risk factor underlying atrial fibrillation and is present in up to 40% of patients with atrial fibrillation. Furthermore, attributable risk studies have shown that a history of hypertension contributes to up to 24% of incident atrial fibrillation. New data suggest that even early forms of hypertension (prehypertension and aortic stiffness) are associated with an increased risk of atrial fibrillation development. Hypertension and prehypertension are therefore critical mediators for the development of atrial fibrillation. Mechanisms for the association between hypertension and atrial fibrillation include diffuse electro-structural changes to the left atrium, driven by the haemodynamic and neurohormonal influences of hypertension and other, frequently coexisting, cardiovascular risk factors. Management of hypertension in atrial fibrillation should focus not only on blood pressure reduction but also on a comprehensive risk factor modification strategy. Such strategies have been shown to be associated with significant improvements in atrial fibrillation symptom burden as well as improved arrhythmia-free survival and reversal of the progression of atrial fibrillation. These strategies should focus on dietary modifications as well as prescribed exercise programmes involving a multidisciplinary team and patient-centred atrial fibrillation care. Risk factor management, supplemented by antihypertensive medications as needed, provides the optimum strategy for improving outcomes and even reversing the natural progression of atrial fibrillation in patients with hypertension.
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Affiliation(s)
- Melissa E Middeldorp
- Centre for Heart Rhythm Disorder, University of Adelaide and the Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Cardiology, Smidt Heart institute, Cedars Sinai Medical Center (CMA), Los Angeles, California, USA
| | - Jonathan P Ariyaratnam
- Centre for Heart Rhythm Disorder, University of Adelaide and the Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Suraya H Kamsani
- Centre for Heart Rhythm Disorder, University of Adelaide and the Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christine M Albert
- Department of Cardiology, Smidt Heart institute, Cedars Sinai Medical Center (CMA), Los Angeles, California, USA
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorder, University of Adelaide and the Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Mariani MV, Pierucci N, Piro A, Trivigno S, Chimenti C, Galardo G, Miraldi F, Vizza CD. Incidence and Determinants of Spontaneous Cardioversion of Early Onset Symptomatic Atrial Fibrillation. Medicina (Kaunas) 2022; 58:1513. [PMID: 36363470 PMCID: PMC9693621 DOI: 10.3390/medicina58111513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 04/12/2024]
Abstract
Atrial fibrillation (AF) is the most frequent chronic arrhythmia worldwide, and it is associated with significant morbidity and mortality, making it a considerable burden both to patients and the healthcare system. Nowadays, an early attempt to restore sinus rhythm in acute symptomatic AF through electrical or pharmacological cardioversion is the most common approach in the Emergency Department (ED). However, considering the high percentage of spontaneous cardioversion of paroxysmal AF reported by many studies, this approach may not be the ideal choice for all patients. In this manuscript we performed a review of the most relevant studies found in literature with the aim of identifying the main determinants of spontaneous cardioversion, focusing on those easy to detect in the ED. We have found that the most relevant predictors of spontaneous cardioversion are the absence of Heart Failure (HF), a small atrial size, recent-onset AF, rapid Atrial Fibrillatory Rate and the relationship between a previous AF episode and Heart Rate/Blood Pressure. A number of those are utilized, along with other easily determined parameters, in the recently developed "ReSinus" score which predicts the likelihood of AF spontaneous cardioversion. Such identification may help the physician decide whether immediate cardioversion is necessary, or whether to adopt a "watch-and-wait" strategy in the presence of spontaneous cardioversion determinants.
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Affiliation(s)
- Marco Valerio Mariani
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Nicola Pierucci
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Agostino Piro
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Sara Trivigno
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Cristina Chimenti
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gioacchino Galardo
- Medical Emergency Unit, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Fabio Miraldi
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Carmine Dario Vizza
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Espnes H, Ball J, Løchen ML, Wilsgaard T, Njølstad I, Mathiesen EB, Gerdts E, Sharashova E. Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study. J Clin Med 2021; 10:jcm10071514. [PMID: 33916428 PMCID: PMC8038622 DOI: 10.3390/jcm10071514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.
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Affiliation(s)
- Hilde Espnes
- Department of Community Medicine, UiT The Arctic University of Norway, 9019 Tromsø, Norway; (M.-L.L.); (T.W.); (I.N.); (E.S.)
- Correspondence: ; Tel.: +47-478-97-212
| | - Jocasta Ball
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, VIC 3130, Australia;
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, 9019 Tromsø, Norway; (M.-L.L.); (T.W.); (I.N.); (E.S.)
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, 9019 Tromsø, Norway; (M.-L.L.); (T.W.); (I.N.); (E.S.)
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, 9019 Tromsø, Norway; (M.-L.L.); (T.W.); (I.N.); (E.S.)
| | - Ellisiv B. Mathiesen
- Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, 9019 Tromsø, Norway;
- Department of Neurology, University Hospital of North Norway, 9019 Tromsø, Norway
| | - Eva Gerdts
- Center for Research on Cardiac Disease in Women, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway;
| | - Ekaterina Sharashova
- Department of Community Medicine, UiT The Arctic University of Norway, 9019 Tromsø, Norway; (M.-L.L.); (T.W.); (I.N.); (E.S.)
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Kim YG, Han KD, Kim DY, Choi YY, Choi HY, Roh SY, Shim J, Kim JS, Choi JI, Kim YH. Different Influence of Blood Pressure on New-Onset Atrial Fibrillation in Pre- and Postmenopausal Women: A Nationwide Population-Based Study. Hypertension 2021; 77:1500-1509. [PMID: 33719508 DOI: 10.1161/hypertensionaha.120.16513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea (Y.G.K., Y.K., Y.Y.C., H.Y.C., S.-Y.R., J.S., J.S.K., J.-I.C., Y.-H.K.)
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea (K.-D.H.)
| | | | - Yun Young Choi
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea (Y.G.K., Y.K., Y.Y.C., H.Y.C., S.-Y.R., J.S., J.S.K., J.-I.C., Y.-H.K.)
| | - Ha Young Choi
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea (Y.G.K., Y.K., Y.Y.C., H.Y.C., S.-Y.R., J.S., J.S.K., J.-I.C., Y.-H.K.)
| | - Seung-Young Roh
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea (Y.G.K., Y.K., Y.Y.C., H.Y.C., S.-Y.R., J.S., J.S.K., J.-I.C., Y.-H.K.)
| | - Jaemin Shim
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea (Y.G.K., Y.K., Y.Y.C., H.Y.C., S.-Y.R., J.S., J.S.K., J.-I.C., Y.-H.K.)
| | - Jin Seok Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea (Y.G.K., Y.K., Y.Y.C., H.Y.C., S.-Y.R., J.S., J.S.K., J.-I.C., Y.-H.K.)
| | - Jong-Il Choi
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea (Y.G.K., Y.K., Y.Y.C., H.Y.C., S.-Y.R., J.S., J.S.K., J.-I.C., Y.-H.K.)
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea (Y.G.K., Y.K., Y.Y.C., H.Y.C., S.-Y.R., J.S., J.S.K., J.-I.C., Y.-H.K.)
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Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S. Intensive systolic blood pressure control and prevention of new onset atrial fibrillation in the SPRINT study: is the association really controversial? Blood Press 2020; 29:199-201. [PMID: 32584173 DOI: 10.1080/08037051.2020.1782595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sverre E Kjeldsen
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Suzanne Oparil
- Vascular Biology and Hypertension Programme, Department of Medicine, University of Alabama at Birmingham, AL, USA
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