Physicians' Academy for Cardiovascular Education

International joint consensus document on hypertension and cardiac arrhythmias

Hypertension and cardiac arrhythmias: executive summary of a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE)

Sep. 20, 2017 - news

Hypertensive heart disease leads to cardiac arrhythmias due to structural and functional pathophysiological changes of the myocardium, as well as due to electrolyte abnormalities caused by antihypertensive therapies. This new consensus document covers all aspects of arrhythmias in hypertensive patients and provides up-to-date recommendations for clinical practice. The statement is evidence-based and mostly based on published data. Evidence and expert opinions from several countries are considered. A ranking of recommendations is indicated, a system that is not directly similar to the categorization by official society guideline recommendations, which also include a grade for the level of evidence. Find below a summary of the most important recommendations.

Recommendations for the management of supraventricular arrhythmias

Recommendations for the management of ventricular arrhythmias

Editorial comment

In their editorial article, Kjeldsen and Wachtell add some comments on AF, as it constitutes >90% of all arrhythmias that occur in people with hypertension and they note that AF is in most cases a typical complication of hypertension, and even more so than stroke or HF.

  • In advanced hypertensive disease, the stiff arteries with high hemodynamically increased afterload and stretch of atrial walls with atrial chamber dilation and pressure up into the pulmonary veins may be a key mechanism for promoting unstable electrical properties that lead to AF.
  • The relationship between the history of hypertension and the risk of AF persists despite confounding by either extensive vascular disease or diabetes, or possibly these diseases even escalate the relationship.
  • When an unfavorable hemodynamic state increases the risk of AF, AF as such should be regarded as target organ damage.
  • Taking annual ECGs may still miss a number of patients with new-onset paroxysmal AF, and newer methods for more continuous monitoring in mega-trials are needed.
  • Data suggest that reducing left atrial size during antihypertensive therapy translates into reduced risk of new-onset AF.

Find this article online at Eur Heart J - Cardiovasc Pharmacother