Atrial fibrillation (AF) and hypertension (HT) are expected to rapidly rise worldwide in the next few
years. Important improvements in AF therapy are hampered by pro-arrhythmic and bleeding risks of current
medications. Prevention of AF is an important matter as it will not only prevent the disease but also medications
side effects, and it is likely to be cost effective. HT is a major contributor to AF. As a modifiable risk factor, its
treatment might reduce new-onset AF, and recurrent AF after cardioversion or ablation as well. We review here
the effect of HT treatment to prevent AF. Renin-angiotensin system (RAS) blockers prevent new-onset AF in
patients at high cardiovascular risk, and especially so in heart failure patients. The evidence is less strong among
hypertensive patients, except in the presence of left ventricular hypertrophy or if at high cardiovascular risk. In
such circumstances, losartan or valsartan were more effective than atenolol or amlodipine. After medical or electrical
cardioversion, RAS blockers favourably affect AF recurrence and this class of drug should figure among the
prescribed antihypertensive medications. Last, the addition of renal denervation to pulmonary vein isolation may
provide even further therapeutic opportunities in patients with refractory HT and AF.
Keywords: Renin-angiotensin system blockade, high cardiovascular risk, heart failure, losartan, valsartan, atenolol, amlodipine, renal denervation.
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