Blood Pressure Control in Atrial Fibrillation
One of Many Critical Components in Risk Factor Modification
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Article, see p 1788
Because of its high prevalence, hypertension is responsible for more atrial fibrillation (AF) than any other risk factors, accounting for 22% of incident AF cases.1 Not only is the presence of hypertension associated with the development of AF, it also is associated with the progression to more persistent forms of AF.2 Furthermore, there is evidence that hypertension is an independent predictor for AF recurrence following catheter ablation.3 The above is of no surprise because both large and small animal studies have clearly demonstrated the adverse effects of hypertension on abnormal atrial remodeling that include slow and heterogenous atrial conduction, increased interstitial fibrosis, and inflammation that result in increased atrial arrhythmogenicity.4,5 Similar findings were seen from electroanatomical right atria mapping in chronically treated hypertensive patients with conduction slowing, areas of low-voltage and increased AF vulnerability.6 It is important to note that these abnormal atrial changes have been shown to be reversible with blood pressure (BP) lowering therapy in a rat study.7 However, there have been no definitive guidelines for the treatment target when treating high BP in AF individuals. It is in this context that the randomized study by Parkash et al on the effect of aggressive BP control on the recurrence of AF after catheter ablation in this issue of Circulation is a welcome addition to the literature.8
This prospective multicenter study recruited 184 patients, with hypertension and symptomatic AF refractory to at least 1 antiarrhythmic drug, who were scheduled for catheter ablation. The subjects were randomized to standard or aggressive BP treatment with systolic BP target of 120 mm Hg or 140 mm Hg, respectively. In the aggressive treatment arm, medications were titrated every other week per home measurements using an automated sphygmomanometer for up to 6 months …