Atrial Fibrillation and Other Arrhythmias in Hypertensive Heart Disease
Several different procedures may be involved in the arrhythmogenesis in hypertensive patients. There is a complex of hemodynamic changes, neuroendocrine factors, atrial and ventricular structural remodeling, and electrophysiological changes that is though
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D. E. Athanasiou, M. S. Kallistratos, L. E. Poulimenos, and A. J. Manolis
14.1 Introduction Cardiovascular disease is the leading cause of death worldwide, and arterial hypertension is the most common risk factor for cardiovascular events [1]. The prevalence of hypertension appears to be around 20–50% in the general population, with an increasing trend, directly related to the aging population [2–4]. Hypertensive heart disease is associated with a variety of cardiac arrhythmias, mostly atrial fibrillation (AF). Arterial hypertension is the most comorbid condition in patients suffering from AF [5]. It has been indicated that arterial hypertension is present in about 60–90% of patients with established AF [6]. Even high-normal blood pressure (BP) is associated with increased incidence of AF [7]. It is estimated that hypertension raises the risk of AF by about twofold [8] and is responsible for 14% of all AF cases [9]. AF represents the most common cardiac arrhythmia affecting approximately 3% of individuals worldwide [10–11]. The prevalence increases up to 10% in the population over 75 years of age [9, 12–13]. AF is considered a major risk factor of stroke, heart failure, sudden death, and overall mortality, as it is associated with a fivefold increase in the risk of stroke, a threefold increase in the risk of heart failure (HF), and a twofold increase in the risk of mortality [14–16]. The presence of hypertension increases the incidence of stroke by threefold annually, and strokes related to AF are more severe [17–20]. The coexistence of hypertension and AF further increases the annual risk of cardiovascular events and especially stroke. Finally, besides AF, other supraventricular arrhythmias and ventricular arrhythmias may occur in the hypertensive patients, especially in those with left ventricular hypertrophy (LVH). D. E. Athanasiou (*) · M. S. Kallistratos · L. E. Poulimenos · A. J. Manolis Cardiology Department, “Asklepeion” General Hospital, Voula, Greece e-mail: [email protected]; [email protected] © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_14
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14.2 M echanisms Underlying AF and Other Cardiac Arrhythmias in Hypertensive Heart Disease Several different procedures may be involved in the arrhythmogenesis in hypertensive patients. There is a complex of hemodynamic changes, neuroendocrine factors, atrial and ventricular structural remodeling, and electrophysiological changes that is thought to contribute to the onset of cardiac arrhythmias [21].
14.2.1 Renin-Angiotensin-Aldosterone System (RAAS) Hypertension is associated with activation of the renin-angiotensin-aldosterone system [22] which has a key role in the development of AF [23]. It has been demonstrated that angiotensin II induces proliferation of fibroblasts and extracellular matrix and leads to atrial myocyte hypertrophy and fibrosis that predispose to AF occurren
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