Hypertension and atrial fibrillation:Closing a virtuous circle

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of major adverse cardiovascular events (MACE). Patients with AF typically have other concomitant cardiovascular risk factors—hypertension being one of the commonly associated conditions with a prevalence of up to 90% in major clinical trials of AF. The association of BP control and reduction in MACE in patients with AF does not come as a surprise as hypertension has been linked not only with adverse cardiovascular outcomes but also with an increased risk of AF. The importance of BP control has previously been shown in a large meta-analysis of 61 prospective observational studies involving 12.7 million person-years, i.e., that there is a linear relation between BP and vascular (and overall) mortality, starting from values of 115/75 mmHg. This IPD meta-analysis by the BPLTTC has shown that the presence of AF does not alter the treatment effects of antihypertensives.