Atrial Fibrillation In Hypertensive Patients Research Articles

Augmentation of Pulmonary Vein Backflow Velocity during Left Atrial Contraction: A Novel Phenomenon Responsible for Progression of Atrial Fibrillation in Hypertensive Patients

Background: Atrial fibrillation (AF) is a common arrhythmia showing disease progression. However, echocardiographic prediction of such progression remains incomplete. This study aimed to identify echocardiographic predictors of AF progression in hypertensive patients. Methods: Hypertensive patients with paroxysmal AF were divided into two groups: patients with AF which became permanent (group A; n = 13) and those with AF which remained paroxysmal (group B; n = 46) during the same follow-up period (8.0 ± 2.4 years). Clinical baselines showed no significant differences except for age. Transthoracic echocardiography was recorded 1–2 weeks after termination of the first-detected paroxysms of AF. Results: Echocardiography showed greater left atrial (LA) dimension (p = 0.023) and late diastolic pulmonary vein (PV) backflow velocity (p < 0.001), and a lower LA fractional shortening (p = 0.008) in group A than in group B. Multilogistic regression analysis demonstrated that augmented PV backflow (p = 0.007) and reduced LA fractional shortening (p = 0.032) were independent predictors of the progression of AF. The receiver-operating characteristic curve demonstrated that PV backflow augmentation is the best predictor of future AF perpetuation. Conclusion: PV backflow leading to cyclic stretching of PV musculature contributes to AF progression.

Doppler‐Derived Indexes and B‐Type Natriuretic Peptide in Prediction of Paroxysmal Atrial Fibrillation in Essential Hypertension: A Prospective Study

Onset of atrial fibrillation in hypertensive patients is usually associated with a high occurrence of cardiovascular complications. Despite its leading importance as a highly prevalent and modifiable risk factor, only a few data are available regarding the predictors of paroxysmal atrial fibrillation (PAF) in hypertensive patients. This study was undertaken to determine if PAF could be predicted in hypertensive patients while in sinus rhythm using Doppler-derived indexes and the plasma B-type natriuretic peptide (BNP) concentration. We prospectively evaluated 165 consecutive patients with hypertension and no known history of PAF or cardiovascular events who attended the cardiology outpatient clinic. Their mean age was 62 +/- 12, 94 male, 71 female. The conventional echocardiographic parameters were measured including: left atrial (LA) volume, mitral regurgitation (MR), left ventricular (LV) function, LV mass. The ratio of transmitral peak E-wave velocity to flow propagation velocity (E/V(p)), ratio of E-wave to mitral annular early diastolic velocity (E/E(a)) obtained by Doppler tissue at the lateral and septal corners of the mitral annulus were calculated. The plasma BNP was measured at the study entry. After a mean follow-up of 15 +/- 3 months, PAF (symptomatic attacks or documented on the ECG) occurred in 36 (21.8%) of 165 patients. The patients with PAF had significant higher BNP levels than those with sinus rhythm (160 +/- 109.8 vs. 87.9 +/- 57.7 pg/ml, P < 0.001) Also, E/E(a) and E/V(p) ratios were significantly higher in hypertensives with PAF (15.1 +/- 2.8 vs. 8.39 +/- 1.33, P < 0.001), and (1.65 +/- 1.29 vs. 1.19 +/- 1.06, P < 0.001) respectively. In univariate analysis, E/V(p), E/E(a), and BNP and LV hypertrophy were significant predictors of PAF. Barely E/V(p) and E/E(a) remained independently significant after adjustment of clinical and other echocardiographic variables by multivariate logistic regression analysis (odd ratio: 3.36, P < 0.001 and 4.93, P < 0.001 respectively). A cutoff value of > or =1.7 for E/V(p) predicted PAF with 91% sensitivity and 88% specificity; E/E(a) >12 has sensitivity 98%, specificity 89%, while BNP>170 pg/ml has 83% and 72% specificity, respectively, for prediction of PAF in hypertensive patients. Paroxysmal atrial fibrillation could be predicted in hypertensive patients while in sinus rhythm using Doppler-derived indexes. Increased E/V(p), E/E(a) ratios and elevated BNP appear to be useful parameters to identify patients at heightened risk. They may reflect early left ventricular dysfunction and atrial hypertension in this population.

Losartan and Prevention of Atrial Fibrillation Recurrence in Hypertensive Patients

The aim of the study was to evaluate the effect of losartan as compared with amlodipine, both associated with amiodarone, in preventing the recurrence of atrial fibrillation (AF) in hypertensive patients with a history of recent paroxysmal atrial fibrillation. Two hundred and fifty mild hypertensive (SBP > 140 mm Hg and/or DBP > 90 < 100 mm Hg) outpatients in sinus rhythm but with at least two ECG-documented episodes of symptomatic atrial fibrillation in the previous 6 months and in treatment with amiodarone were randomized to losartan or amlodipine and were followed up for 1 year. Clinic blood pressure (BP) and a 24-hour ECG was evaluated every month; the patients were asked to report any episode of symptomatic atrial fibrillation and to perform an ECG as early as possible. Two hundred and thirteen patients completed the study, 107 in the losartan group and 106 in the amlodipine group. After 12 months the SBP/DBP mean values were significantly reduced by both losartan (from 151.4/95.6 to 135.5/83.7 mm Hg, P < 0.001 versus baseline) and amlodipine (from 152.3/96.5 to 135.2/83.4 mm Hg, P < 0.001 versus baseline), with no difference between the two treatments. At least one ECG-documented episode of atrial fibrillation was reported in 13% of the patients treated with losartan and in 39% of the patients treated with amlodipine. The use of losartan in combination with amiodarone seems more effective than amlodipine/amiodarone combination in preventing new episodes of atrial fibrillation in hypertensive patients with recurrent atrial fibrillation. This might be related to possible favorable impact of angiotensin II receptor blockers (ARB) on the atrial electrical and structural remodeling in this type of patients.

Role of Angiotensin-1-Receptor Blockers In Cardiorenal Disease

Arterial hypertension is one of the most important risk factors for cardiovascular disease. Angiotensin-1- receptor blockers (ARB) are a class of drugs that potently inhibit the vasoconstriction and other vascular effects of angiotensin including proliferation of vascular smooth muscle cells by selective binding to the AT1-receptor. The present review summarizes the most relevant experimental and clinical data on this new class of drugs. ARBs inhibit effects of angiotensin II on the vasoconstriction and proliferation of vascular smooth muscle cells, reduce sympathetic activation, increase bradykinin dependent vasodilator effects and increase Ang(1-7), a metabolite of angiotensin, which has vascular protective properties. ARBs also interfere with the interactions of the renin-angiotensinsystem with both the endothelin-system and the sympathetic nervous system. Under in vivo conditions in men, ARBs have a potent antihypertensive effect and have fewer side effects than any other class of antihypertensives. The available ARBs differ regarding their metabolism, plasma half-life and trough-to-peakratio. Several clinical trials have proven that ARBs are safe and effective in reducing morbidity and mortality in hypertension, diabetic and non-diabetic renal disease, acute myocardial infarction as well as systolic and diastolic heart failure. Importantly, protection from cerebrovascular disease and from cardiovascular disease after stroke is an emerging property of ARBs and is likely to be partially independent from the blood-pressure lowering effects. ARBs, similarly to ACE-inhibitors and in contrast to diuretics, have proven to reduce the incidence on new-onset diabetes, which is likely to be clinically relevant in the chronic treatment of hypertension and cardiac disease. Furthermore, ARBs reduce the incidence of atrial fibrillation in hypertensive patients. The reasons for these beneficial effects of ARBs are discussed and include improvement of endothelial function and renal hemodynamics, reduction in central nervous sympathetic tone, interaction with the endothelin-system and potent reduction of left ventricular hypertrophy. Thus, ARBs are an important new, well tolerated class of cardiovascular drugs, which reduce morbidity and mortality from cardiac, renal and cerebrovascular disease. Keywords: stroke, antiproliferative, antihypertensive, cerebrovascular events, Diabetic nephropathy, fibrillation

Can losartan prevent new-onset atrial fibrillation in hypertensive patients more effectively than atenolol?

Can losartan prevent new-onset atrial fibrillation in hypertensive patients more effectively than atenolol?

757 Raised NT-pro ANP plasma levels is independently associated with an increased risk for paroxysmal atrial fibrillation in hypertensive patients

757 Raised NT-pro ANP plasma levels is independently associated with an increased risk for paroxysmal atrial fibrillation in hypertensive patients

The comparative effects of telmisartan and ramipril on P-wave dispersion in hypertensive patients: A randomized clinical study

Prolongation of P-wave times and increase of P-wave dispersion (PWD) were shown to be independent predictors of atrial fibrillation (AF). Angiotensin II receptor blockers (AARBs) and angiotensin-converting enzyme inhibitors (ACEIs) have beneficial effects on atrial conduction times. However, there are not enough data about the comparative effects of those drugs on PWD. We aimed to compare the effects of telmisartan and ramipril on PWD after 6-month treatment in hypertensive patients. In all, 100 newly diagnosed hypertensive patients were enrolled in the study and were randomly assigned to two groups. Group 1 and Group 2 each consisted of 50 patients, taking daily doses of 80 mg telmisartan and 10 mg ramipril, respectively. Twelve-lead surface electrocardiograms (ECG) were recorded from all patients before and after 6-month drug therapy. The P-wave duration (Pdur) measurements were calculated from the 12-lead surface ECG. When pretreatment PWD and Pmaximum values were compared with post-treatment values, a statistically significant decrease was found in both groups after 6 months (Group 1 and 2; p < 0.001 for PWD and Pmaximum). P-wave dispersion and Pmaximum values after treatment in Group 1 were statistically significantly lower than those in Group 2 after the 6-month treatment period (p = 0.01 for PWD; p = 0.008 for Pmaximum). Telmisartan has a much greater lowering effect on PWD and Pmaximum values than ramipril. This finding may be important in the prevention of AF in hypertensive patients.

757 Raised NT-pro ANP plasma levels is independently associated with an increased risk for paroxysmal atrial fibrillation in hypertensive patients

757 Raised NT-pro ANP plasma levels is independently associated with an increased risk for paroxysmal atrial fibrillation in hypertensive patients

High levels of brain natriuretic peptide and prolonged P-wave dispersion are associated with an increased risk of paroxysmal atrial fibrillation in hypertensive patients

High levels of brain natriuretic peptide and prolonged P-wave dispersion are associated with an increased risk of paroxysmal atrial fibrillation in hypertensive patients

Raised BNP is indepently associated with an increased risk for paroxysmal atrial fibrillation in hypertensive patients

Raised BNP is indepently associated with an increased risk for paroxysmal atrial fibrillation in hypertensive patients

The signal-averaged P-wave duration is longer in hypertensive patients with history of paroxysmal atrial fibrillation as compared to those without

Background Onset of atrial fibrillation in hypertensive patients is usually associated with a high occurrence of cardiovascular complications. Therefore, it is important to assess non-invasively the risk of developing paroxysmal atrial fibrillation (PAF) in hypertensive patients during sinus rhythm. This study was undertaken to determine if hypertensive patients with history of PAF could be identified while in sinus rhythm by measurement of signal-averaged ECG P-wave duration. Methods Signal-averaged electrocardiography (SAECG) P-wave recording was performed in 44 hypertensive patients (30 men and 14 women; mean age 60±11 years, group A) who had a history of paroxysmal AF and in 50 hypertensive patients without history of AF (33 men and 17 women; mean age 57±12, group B). All patients were also evaluated by using echocardiography to measure left ventricular ejection fraction (LVEF) and left atrial diameter (LAD). Results SAECG P-wave duration was found to be significantly higher in group A than in group B (146±14 ms vs. 128±11 ms, p<0.001). Left atrial diameter was not significantly different (40.1±3.4 mm vs. 39.3±3.0 mm, p>0.05), whereas LVEF was significantly lower in group A than group B (63±5% vs. 67±4%, p=0.03). There was a correlation between SAECG P-wave duration and age ( r=0.32, p<0.05). In univariate analysis, SAECG P-wave duration and LVEF were significant predictors of PAF, but only SAECG P-wave duration remained a significant independent predictor of PAF in multivariate analysis. Conclusion The results of this study indicate that hypertensive patients with history of PAF can be detected while in sinus rhythm by signal-averaged ECG P-wave duration.

Impaired atrial function after conversion of atrial fibrillation in hypertensive patients

P-366 Key Words: Hypertrophy, Left Atrium, Atrial Function

Is arterial stiffness a contributing factor to atrial fibrillation in patients with hypertension? A preliminary investigation

Background Atrial fibrillation (AF) is the most common tachyarrhythmia encountered by clinicians. When AF occurs in patients with structural disorders, hypertension is most common. Hypertension may provoke or enable AF to occur through several mechanisms. One could be the resultant effects of increased afterload on the left ventricle and consequent changes in the left atrium. The latter could be the direct linear effect of elevated diastolic atrial pressure and its proximate effect on atrial electrophysiology. Alternatively, it may be a more indirect and complex relationship involving chronic morphologic, electrophysiologic, and secretory consequences in the atrium consequent to a chronically reduced left ventricular (LV) compliance. Methods To assess this relationship, the arterial stiffness index (ASI) was determined in 53 hypertensive patients (29 with AF, 24 without) and 17 nonhypertensive controls with AF and its relationship to ventricular hypertrophy and AF was determined. All except 5 patients with AF had paroxysmal AF (PAF); the other 5 were in sinus rhythm status after cardioversion of a persistent AF episode. Results The ASI was significantly higher in patients with hypertension, both with and without AF than in lone AF patients, but did not distinguish between hypertensives with and without AF. The ASI was higher in the presence of LV hypertrophy (LVH). Conclusions The ASI and LVH cannot be used to predict the risk of AF in hypertensive patients and the development of AF in hypertensives is more complex than just that of the immediate effect of elevated ventricular pressure on atrial pressure and stretch. Rather, AF is linked through the chronic alterations that are consequent to atrial hypertension.

2718 Losartan reduces the risk of new-onset atrial fibrillation in hypertensive patients with electrocardiogram left-ventricular hypertrophy: the LIFE study

2718 Losartan reduces the risk of new-onset atrial fibrillation in hypertensive patients with electrocardiogram left-ventricular hypertrophy: the LIFE study

Atrial fibrillation in hypertensive patients: Effect on atrial filling

Atrial fibrillation in hypertensive patients: Effect on atrial filling

Empleo de fármacos antitrombóticos en pacientes hipertensos con fibrilación auricular crónica. Estudio CARDIOTENS 99

Our main goals were to know the actual degree of oral anticoagulation and antiaggregation in hypertensive patients with atrial fibrillation in the daily clinical practice in Spain and to analyze any differences between primary care physicians and cardiologists. 32,051 outpatients attended the same day by 1,159 physicians (21% cardiologists) were prospectively included in a database taking into account a history of hypertension and atrial fibrillation, demographic data and ongoing treatments. Hypertension was detected in 10,555 patients and 999 of them had both hypertension and atrial fibrillation (9.46%: 435 males [44%] and 564 females [56%]). 53% patients were attended by primary care physicians and the rest by cardiologists. 33% of hypertensive patients with atrial fibrillation were on oral anticoagulation: 41% of them attended by cardiologists and 26% by primary care physicians (p < 0.05). These differences persisted when the patients were compared on the basis of their age. 39% of hypertensive patients were on oral antiaggregation treatment, without differences in both groups except for those aged less than 65 years who were found to receive more antiaggregation in primary care (36% vs 24%; p < 0.05). The prevalence of atrial fibrillation in hypertensive patients is about 10%; there is a suboptimal degree of utilization of oral anticoagulation, which is more evident in patients attended by primary care physicians; elderly patients (> 80 years-old) were found to receive less anticoagulants and more antiaggregants both in primary health-care and cardiology health-care.

Atrial function and size after conversion of atrial fibrillation in hypertensive patients

Atrial function and size after conversion of atrial fibrillation in hypertensive patients

Clinical study to investigate the predictive parameters for the onset of atrial fibrillation in patients with essential hypertension

Background The risk factors involved in the onset of atrial fibrillation (AF) are well known, but the predictive clinical and paraclinical parameters for the onset of AF in hypertensive patients have not been investigated specifically. Methods and Results We retrospectively analyzed 97 consecutive patients with hypertension and no known history of AF or cardiovascular events who attended the cardiology outpatient clinic. The analysis was based on clinical data, the noninvasive ambulatory 24-hour measurement of blood pressure (AMBP), a standard 12-lead electrocardiogram, and a Doppler echocardiogram. After a mean follow-up of 25 ± 3 months, 19 (19.5%) patients had AF, 3 (15.8%) of whom had a cerebrovascular accident. The patients with AF were older than the others and their AMBP showed higher mean systolic diurnal and nocturnal blood pressures, though no differences in the clinical blood pressure readings were present. On the electrocardiogram, the maximum duration of the P wave and its dispersion were more prolonged in the patients with AF. On the Doppler echocardiogram, left ventricular mass and left atrial dimension were higher in the patients with AF, and the A-wave velocity of diastolic mitral flow was reduced in these patients. In the multivariate analysis, age (odds ratio 3.28, P < .001), diurnal systolic blood pressure (odds ratio 1.35 P < .01) and nocturnal systolic blood pressure (odds ratio 1.16, P < .01), maximum duration of the P wave (odds ratio 2.09, P < .01), dispersion of the P wave (odds ratio 2.52, P < .001), echocardiographic left ventricular mass (odds ratio 1.43, P < .01), left atrial dimension (odds ratio 2.81, P < .001), and velocity of the A wave (odds ratio 2.24, P < .01) were independent predictors for the onset of AF. After correction for age, maximum duration of the P wave (odds ratio 1.34, P < 001), dispersion of the P wave (odds ratio 1.63, P < .001), and the velocity of the A wave (odds ratio 1.42, P < .01) remained independent predictors for the onset of AF. Conclusions In patients with hypertension, age and the level of diurnal and nocturnal systolic blood pressures measured by 24-hour AMBP are important independent predictors for the onset of AF. Independent of age, increases in left atrial dimension and left ventricular mass, prolongation of the maximum duration and dispersion of the P wave and reduced A-wave velocity are also predictors for the onset of AF.