Can hypertension (HTN) cause atrial fibrillation (A-fib)?

From the Guidelines

Hypertension (HTN) is a significant risk factor for the development of atrial fibrillation (A-fib), and controlling blood pressure is crucial for reducing A-fib risk. Chronic high blood pressure causes structural changes in the heart, including left atrial enlargement and left ventricular hypertrophy, which create an environment conducive to A-fib development 1. The increased pressure forces the heart to work harder, leading to stretching and thickening of heart chambers, disrupting normal electrical conduction pathways and creating areas of fibrosis that can trigger and sustain irregular heart rhythms.

Some key points to consider in the management of hypertension to reduce A-fib risk include:

• Controlling blood pressure with appropriate medications, such as ACE inhibitors, ARBs, calcium channel blockers, or diuretics, is essential 1.
• Patients with hypertension should aim for blood pressure targets below 130/80 mmHg to minimize cardiac remodeling and reduce the likelihood of developing atrial fibrillation 1.
• Treatment of hypertension may prevent new-onset A-fib, especially in patients with left ventricular hypertrophy (LVH) or left ventricular dysfunction 1.
• Angiotensin receptor blockers (ARBs) may be useful for the prevention of recurrence of A-fib 1.

Overall, managing hypertension is a critical component of reducing the risk of developing atrial fibrillation, and healthcare providers should prioritize blood pressure control in patients with hypertension to minimize cardiac remodeling and reduce the likelihood of A-fib 1, 1.

From the Research

Hypertension and Atrial Fibrillation

• Hypertension is the most prevalent cardiovascular risk factor underlying atrial fibrillation, present in up to 40% of patients with atrial fibrillation 2.
• Attributable risk studies have shown that a history of hypertension contributes to up to 24% of incident atrial fibrillation 2.
• Hypertension is associated with a 1.8-fold increase in the risk of developing new-onset atrial fibrillation and a 1.5-fold increase in the risk of progression to permanent atrial fibrillation 3.
• The renin angiotensin aldosterone system has been demonstrated to be a common mechanistic link in the pathogenesis of hypertension and atrial fibrillation 3.

Mechanisms and Risk Factors

• 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 2.
• Hypertension predisposes to cardiac structural changes that influence the development of atrial fibrillation, such as atrial remodeling 3.
• Hypertensive patients have up to 73% greater likelihood of atrial fibrillation 4.

Management and Prevention

• Management of hypertension in atrial fibrillation should focus not only on blood pressure reduction but also on a comprehensive risk factor modification strategy 2.
• Antihypertensive treatment may contribute to reduce the risk of atrial fibrillation, and some classes are superior to others in the prevention of new-onset atrial fibrillation and prevention of stroke 5.
• 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 4.
• Antihypertensive therapy effectively lowers atrial fibrillation risk, particularly in individuals with left ventricular dysfunction 6.