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Hypertension and atrial fibrillation: diagnostic approach, prevention and treatment. Position paper of the Working Group ‘Hypertension Arrhythmias and Thrombosis’ of the European Society of Hypertension

Manolis, Athanasios J.a; Rosei, Enrico Agabitib; Coca, Antonioc; Cifkova, Renatad; Erdine, Serap E.e; Kjeldsen, Sverref; Lip, Gregory Y.H.g; Narkiewicz, Krzysztofh; Parati, Gianfrancoi; Redon, Josepj; Schmieder, Rolandk; Tsioufis, Costasl; Mancia, Giuseppem

doi: 10.1097/HJH.0b013e32834f03bf

Hypertension is the most common cardiovascular disorder and atrial fibrillation is the most common clinically significant arrhythmia. Both these conditions frequently coexist and their prevalence increases rapidly with aging. There are different risk factors and clinical conditions predisposing to the development of atrial fibrillation, but due its high prevalence, hypertension is still the main risk factor for the development of atrial fibrillation. Several pathophysiologic mechanisms (such as structural changes, neurohormonal activation, fibrosis, atherosclerosis, etc.) have been advocated to explain the onset of atrial fibrillation. The presence of atrial fibrillation per se increases the risk of stroke but its coexistence with high blood pressure leads to an abrupt increase of cardiovascular complications. Different risk models are available for the risk stratification and the prevention of thromboembolism in patients with atrial fibrillation. In all of them hypertension is present and is an important risk factor. Antihypertensive treatment may contribute to reduce this risk, and it seems some classes are superior to others in the prevention of new-onset atrial fibrillation and prevention of stroke. Antithrombotic treatment with warfarin is effective in the prevention of thromboembolic events, although quite recently, new classes of anticoagulants that do not require international normalized ratio monitoring have been introduced with promising results.

aDepartment of Cardiology, Asklepeion General Hospital, Athens, Greece

bDepartment of Medical and Surgical Sciences, Clinic of Internal Medicine, University of Brescia, Brescia, Italy

cHypertension Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain

dDepartment of Preventive Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic

eSchool of Medicine, Istanbul University Cerrhpa, Istanbul, Turkey

fDepartment of Cardiology, Ullevaal University Hospital, Oslo, Norway

gHaemostasis Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK

hDepartment of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland

iDepartment of Clinical Medicine and Prevention, University of Milano-Bicocca; Centro Interuniversitario di Fisiologia Clinica e Ipertensione & Department Cardiology, S Luca Hospital, Istituto Auxologico Italiano, Milan, Italy

jINCLIVA Internal Medicine Hospital Clinico, University of Valencia, Valencia, Spain

kMedizinische Klinik, University Erlangen-Nuernberg, Erlangen, Germany

l1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece

mClinica Medica, University of Milano-Bicocca, Ospedale San Gerardo, Milan, Italy

Correspondence to Athanasios J. Manolis, Department of Cardiology, Asklepeion General Hospital, 1 V. Pavlou str., Athens 16672, Greece. Tel: +302108923630; fax: +302108923209; e-mail:

Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; b.i.d., bis in die (twice a day); CCB, calcium channel blockers; ESC, European Society of Cardiology; ESH, European Society of Hypertension; FDA, Federal Drug Association; hs-CRP, highly sensitive C-reactive protein; INR, international normalized ratio; LVH, left ventricular hypertrophy; RAS, renin–angiotensin system; VKA, vitamin K antagonist

Received 29 June, 2011

Revised 8 November, 2011

Accepted 8 November, 2011

© 2012 Lippincott Williams & Wilkins, Inc.