Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and beta blockers (BBs) are the drugs of choice for rate or rhythm control in these patients. The purpose of this study was to describe differences in arterial stiffness (AS), central blood pressure (cBP), and the role of BBs on cBP in patients with AF compared to healthy individuals. The authors included 76 patients with paroxysmal/persistent AF. Carotid‐femoral pulse wave velocity (PWV) and cBP were measured and compared with data from 75 healthy individuals. Patients with AF had higher PWV (8.0 m/s vs. 7.2 m/s, p < .001), central systolic blood pressure (cSBP) (118 mm Hg vs. 114 mm Hg, p = .033), central pulse pressure (cPP) (39 mm Hg vs. 37 mm Hg, p = .035) and lower pulse pressure amplification (PPA) (1.24 vs. 1.30, p = .015), without differences in peripheral blood pressure (pBP) and heart rate (HR). AF patients had significantly increased PWV (β= 0.500, p = .010, adjusted R² = 0.37) after adjustment for confounding factors. The use of BBs significantly reduced PPA (β = ‐0.059, p = .017, adjusted R² = 0.30). AF patients have higher PWV, cSBP, cPP, and lower PPA, compared to healthy patients. These findings support the role of AS in the development of AF. Use of BBs is related to a potential adverse effect on cBP.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and remains one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity in the world.[1]
Due to the pulse pressure amplification (PPA) phenomenon occurring across the arterial tree, blood pressure (BP) and pulse pressure (PP) are known to be higher when assessed at the brachial artery compared to the aorta.[2]
In a multiple linear regression analysis with PPA as a dependent variable, where body mass index, diagnosis of hypertension, use of angiotensin-converting enzyme inhibitors (AKEIs) or angiotensin receptor blockers (ARBs), and use of beta blockers (BB) were considered as independent variables, the use of BBs was associated with significantly lower PPA (β = -0.059, p = .017)
Summary
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and remains one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity in the world.[1]. Due to the pulse pressure amplification (PPA) phenomenon occurring across the arterial tree, blood pressure (BP) and pulse pressure (PP) are known to be higher when assessed at the brachial artery (peripheral blood pressure–pBP) compared to the aorta (central blood pressure–cBP).[2] Arterial stiffness (AS) and cBP are increasingly recognized important risk factors for cardiovascular disease,[3,4,5,6] but they have rarely been studied in AF patients (Figure 1). Beta blockers (BBs) are the first-choice drugs for long-term rate and initial rhythm control for patients with AF. They are used less often for patients with hypertension because of their unfavorable effects on cBP compared to other antihypertensive medications.[7,8] Existing recommendations are somewhat
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