PS-R02-7: PAROXYSMAL ATRIAL FIBRILLATION IN A PATIENT WITH HYPERTENSION: A CASE REPORT

Abstract

Objective: To present the association between arterial hypertension and concomitant arrhythmias. Summary: The report examines a case of a 74-year-old female patient with known arterial hypertension. She presented with wide blood pressure (BP) fluctuations, with surges of very high BP during the last three months. She also experienced palpitations, dyspnea and chest pain. BP measurements ranged from 116/67 mmHg in the office to 235/103 mmHg at home. She had been taking telmisartan 40 mg once-daily (OD), lercanidipine 10 mg OD and bisoprolol 5 mg OD regularly for several years and her BP was previously well controlled. Considering the discrepancy between BP measurements in the office and at home, we decided against changing her regular therapy. Therefore, the patient was advised to continue current antihypertensive treatment and additionally take captopril 25 mg and/or sublingual nitroglycerin when systolic BP was above 150 mmHg. Further diagnostics was performed. Transthoracic echocardiogram was normal, except for moderately enlarged left atrium. Pulmonary embolism and obstructive coronary artery disease were excluded. 24-hour Holter ECG revealed that the patient had symptomatic paroxysmal AF with rapid ventricular response (Figure 1a). There were also some sinus pauses and short periods of sinus bradycardia immediately after the cessation of AF paroxysm (Figure 1b). To reduce AF-related symptoms and improve the quality of life, the patient was referred to catheter ablation. Pulmonary vein isolation was successfully achieved with no periprocedural complications. Due to borderline sinus bradycardia, bisoprolol was temporarily discontinued and later reintroduced in a lower dose. After the procedure, she was regularly taking telmisartan 40 mg OD, lercanidipine 10 mg OD, bisoprolol 1.25 mg OD, a direct oral anticoagulant and a statin. 24-hour ambulatory blood pressure monitoring was performed. A 24-hour mean BP was 112/66 mmHg, mean day-time BP was 115/69 and mean night-time BP was 108/62 mm Hg (Figure 1c). There was no excessive fluctuation in BP. Furthermore, no increases in HR were noted that would suggest recurrence of AF paroxysms. Conclusion: The patient, who was referred to our outpatient hypertension clinic due to uncontrolled hypertension, was diagnosed with symptomatic paroxysmal AF. By means of a successful AF catheter ablation, we eliminated the excessive BP fluctuations. AF and hypertension are closely related, and the appearance of AF can lead to poor BP control. An appropriate treatment for AF in patients with hypertension contributes to better control of the hypertension itself.