Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Jenny, D.
The impact of arterial hypertension on atrial fibrillation and recent evidence-based therapy
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp. 53
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Rohrer Ursula
- Scherr Daniel
- Altmetrics:
- Abstract:
- Background: Due to better medical care, the population is increasingly reaching a higher age. This has a particular impact on the prevalence of atrial fibrillation as its incidence rises with age. Arterial hypertension as an isolated risk factor has a strong influence on the development and progression of the arrhythmia. Objective: The aim of this work is to demonstrate the influence of arterial hypertension on the development and progression of atrial fibrillation with special regard to structural and electrical remodeling. In addition, the literature is searched for evidence-based therapeutic options to optimally treat both medical conditions. Methods: An extensive literature search was performed in Pubmed, UptoDate, ClinicalTrials.gov and ScienceDirect. Results: Atrial dilatation is an important sign of structural remodeling and can be used as a prognostic marker for the development of atrial fibrillation. Dilatation of the atria is aggravated by hypertension on the one hand and by atrial fibrillation itself on the other ("atrial fibrillation begets atrial fibrillation"). Furthermore, arterial hypertension leads to increased fibrosis of the atria. Electrical remodeling leads to a variety of ion-channel changes (mainly Ca2+-ion channels) which eventually result in a reduction of atrial effective refractory periods. These changes are reversible to some degree as atrial fibrillation is terminated. Angiotensin converting enzymes and angiotensin receptor blockers reduce the rate of new-onset atrial fibrillation compared to other conventional drugs used to lower blood pressure. If atrial fibrillation is already present, a multimodal therapeutic approach is recommended to optimally treat the arrhythmia. Conclusion: Despite extensive research within the last years the exact mechanism of origin and perpetuation of atrial fibrillation as well as the influence of arterial hypertension as the most important risk factor remain unclear. Further studies need to be done to reveal the exact mechanism so that treatment measures can be taken early.