Hypertension and
atrial fibrillation (AF) are 2 important public health priorities. Their prevalence is increasing worldwide, and the 2 conditions often coexist in the same patient.
Hypertension and AF are strikingly related to an excess risk of
cardiovascular disease and death.
Hypertension ultimately increases the risk of AF, and because of its high prevalence in the population, it accounts for more cases of AF than other risk factors. Among patients with established AF,
hypertension is present in about 60% to 80% of individuals. Despite the well-known association between
hypertension and AF, several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. From an epidemiological standpoint, it is unclear whether the increasing risk of AF with blood pressure (BP) is linear or threshold. It is uncertain whether an intensive control of BP or the use of specific
antihypertensive drugs, such as those inhibiting the renin-angiotensin-aldosterone system, reduces the risk of subsequent AF in hypertensive patients in sinus rhythm. Finally, in spite of the observational evidence suggesting a progressive relation between BP levels and the risk of
thromboembolism and
bleeding in patients with
hypertension and AF, the extent to which BP should be lowered in these patients, including those who undergo
catheter ablation, remains uncertain. This article summarizes the main basic mechanisms through which
hypertension is believed to promote AF. It also explores epidemiological data supporting an evolutionary pathway from
hypertension to AF, including the emerging evidence favoring an intensive BP control or the use of drugs, which inhibit the renin-angiotensin-aldosterone system to reduce the risk of AF. Finally, it examines the impact of non-
vitamin K antagonist oral
anticoagulants compared with
warfarin in relation to
hypertension.