A large percentage of patients with hypertension suffer from atrial fibrillation (AF). The concomitance of both conditions in the same patient markedly increases cardiovascular risk. Therefore, prevention of new-onset AF in hypertensive population should be a relevant target.
High blood levels promote structural and electrophysiological changes in the heart that promote the development of AF. Thus, the most important therapeutic approach to prevent incident AF in hypertensive population is to reduce blood pressure values to recommended goals. However, in specific conditions, some antihypertensive agents may provide additional benefits beyond blood pressure reduction, such as in hypertension with left ventricular hypertrophy with renin angiotensin system blockade. On the other hand, in patients with hypertension and permanent AF, beta blockers and nondihydropiridine calcium antagonists (verapamil and diltiazem) play an important role.
Antihypertensive agents may provide beneficial effects on incident AF, regardless the presence of hypertension. Thus, renin angiotensin system inhibitors may reduce new-onset AF in patients with heart failure or after the cardioversion of persistent AF. On the other hand, the preoperative administration of beta blockers may reduce the incidence of postoperative AF in some patients.
In this manuscript, the available evidence about the effects of different antihypertensive agents on new-onset AF in different populations is reviewed
Credits: Vivencio Barrios, MD, PhD; Carlos Escobar, MD, PhD