Marazzato Jacopo, Blasi Federico, Golino Michele, Verdecchia Paolo, Angeli Fabio, De Ponti Roberto
Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
Fondazione Umbra Cuore e Ipertensione-ONLUS, 06100 Perugia, Italy.
J Cardiovasc Dev Dis. 2022 Apr 6;9(4):110. doi: 10.3390/jcdd9040110.
Because of demographic aging, the prevalence of arterial hypertension (HTN) and cardiac arrhythmias, namely atrial fibrillation (AF), is progressively increasing. Not only are these clinical entities strongly connected, but, acting with a synergistic effect, their association may cause a worse clinical outcome in patients already at risk of ischemic and/or haemorrhagic stroke and, consequently, disability and death. Despite the well-known association between HTN and AF, several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. Although several trials reported the overall clinical benefit of renin-angiotensin-aldosterone inhibitors in reducing incident AF in HTN, the role of this class of drugs is greatly reduced when AF diagnosis is already established, thus hinting at the urgent need for primary prevention measures to reduce AF occurrence in these patients. Through a thorough review of the available literature in the field, we investigated the basic mechanisms through which HTN is believed to promote AF, summarising the evidence supporting a pathophysiology-driven approach to prevent this arrhythmia in hypertensive patients, including those suffering from primary aldosteronism, a non-negligible and under-recognised cause of secondary HTN. Finally, in the hazy scenario of AF screening in hypertensive patients, we reviewed which patients should be screened, by which modality, and who should be offered oral anticoagulation for stroke prevention.
由于人口老龄化，动脉高血压（HTN）和心律失常（即心房颤动，AF）的患病率正在逐渐上升。这些临床病症不仅紧密相关，而且它们相互协同作用，这种关联可能会使已经有缺血性和/或出血性中风风险的患者临床结局更差，进而导致残疾和死亡。尽管HTN与AF之间的关联广为人知，但高血压患者发生AF风险较高的几种发病机制仍未完全明确。虽然多项试验报告了肾素 - 血管紧张素 - 醛固酮抑制剂在降低HTN患者发生AF方面的总体临床益处，但当AF诊断已经确立时，这类药物的作用会大大降低，这表明迫切需要采取一级预防措施来减少这些患者发生AF。通过全面回顾该领域的现有文献，我们研究了HTN被认为促进AF的基本机制，总结了支持以病理生理学为导向的方法来预防高血压患者（包括那些患有原发性醛固酮增多症的患者，这是继发性HTN一个不可忽视且未得到充分认识的原因）发生这种心律失常的证据。最后，在高血压患者AF筛查的模糊情况下，我们回顾了哪些患者应该接受筛查、通过何种方式进行筛查以及哪些患者应该接受口服抗凝治疗以预防中风。
