The article presents own experience of treating patients with atrial fibrillation. Asymptomatic lesion of the target organ is detected in patients with arterial hypertension in the early stages of the disease before obvious clinical manifestations. The question of studying the mutual influence of arterial hypertension and atrial fibrillation is important, because this combination significantly increases the risk of cardiovascular events. The study included 55 patients with hypertension and recurrent atrial fibrillation by the prescription of an average of 11 months with an average frequency of 2 episodes a year. All were performed applanation tonometry, echocardiography and daily monitoring of blood pressure. The patients were allocated on the 3 groups. Groups differed significantly by age, the risk of thromboembolic complications on a scale CHA2-DS2-VASc score, creatinine level. Patients with increased arterial stiffness had the highest heart rate, a shorter return time of the pulse wave and a higher augmentation index at comparable values of peripheral and central systolic and diastolic blood pressure. Multivariate regression analysis found that independent predictors of recurrent relapses of atrial fibrillation in patients with arterial hypertension were age, higher the index on a scale CHA2-DS2-VASc score and the creatinine levels, the return of the reflected wave. In the group of patients with arterial hypertension and normal arterial stiffness the positive correlation of the recurrence of atrial fibrillation with age, scale CHA2-DS2- VASc score, creatinine level, and the maximum daily heart rate. It is necessary to highlight the role of the reflected wave in the modification of arterial stiffness in patients with arterial hypertension and the velocity of propagation of pulse wave ≥10 m/s, making rational control of heart rate in case reduced elastic properties of arteries.
arterial stiffness, pulse wave velocity, arterial hypertension, recurrent atrial fibrillation
1. Balabanenko I.M, Shavarov A.A., Kiyakbaev G.K. Vliyanie fibrillyatsii predserdiy na strukturnye i funktsional´nye izmeneniya levogo predserdiya u patsientov s arterial´noy gipertoniey.. Klin.farmamol. ter. 2015. 24 (3). S. 53-56.
2. Rekomendatsii RKO, VNOA i ASSKh. Diagnostika i lechenie fibrillyatsii predserdiy / Sulimov V.A. [i dr.], 2012.
3. Yusupov A.A., Shavarov A.A., Kiyakbaev G.K., Moiseev V.S. Vliyanie amiodarona i sotalola na morfofunktsional´nye parametry levogo predserdiya u bol´nykh ishemicheskoy bolezn´yu serdtsa s retsidiviruyushchey fibrillyatsiey predserdiy. Klin. farmakol. ter. 2015. 24 (1). C. 38-43.
4. Agoston-Soldea N., Mocan T., Bobar C. Arterial stiffness and left ventricular diastolic function in the patients with hypertension. Rom J Intern Med. 2008. 46(4). 313-321.
5. Asmar R., Topouchian J., Pannier B. et al. Pulse wave velocity as endpoint in large-scale intervention trial. The COMPLIOR study //J Hypertens. 2001. 19. P. 813-818.
6. Bansal N., Fan D., Hsu C.Y. et al. Incident Atrial Fibrillation and Risk of End-Stage Renal Disease in Adults with Chronic Kidney Disease. Circulation.2012;CIRCULATIONAHA.112.123992
7. Benjamin E.J., Levy D., Vaziri S.M., D´Agostino R.B., Belanger A.J., Wolf P.A. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study //JAMA. 1994. 271. P. 840-844.
8. Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC) / Camm A.J., Kirchhof P., Lip G.Y. [et al.]. Eur Heart J. 2010. 31 (19). P. 2369-429.
9. Relationship between the CHADS(2) score and risk of very late recurrences after catheter ablation of paroxysmal atrial fibrillation / Chao T.F., Ambrose K., Tsao H.M. [et al.] //Heart Rhythm. 2012. V. 9. P. 1185- 1191.
10. Heart Rate Significantly Influences the Relationship between Atrial Fibrillation and Arterial Stiffness / Chu C.Y., Lin T.H., Hsu P.C., Lee W.H., Lee H.H., [et al.]. Int J Med Sci. 2013.10(10). P. 1295-300.
11. Conen D., Tedrow U.B., Koplan B.A., Glynn R.J., Buring J.E., Albert C.M. Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women. Circulation. 2009. 119. P. 2146- 2152.
12. Left atrial structure and function in atrial fibrillation: ENGAGE AF-TIMI 48 / Deepak K. Gupta, Amil M. Shah, Robert P. Giugliano [et al.]. European Heart Journal. 2014. 35. P. 1457-1465.
13. Prediction of atrial fibrillation recurrence after cardioversion in patients with left-atrial dilation / Fornengo C., Antolini M., Frea S. [et al.]. Eur Heart J Cardiovasc Imaging. 2015. V. 16. P. 335-341.
14. Furberg C.D., Psaty B.M., Manolio T.A., Gardin J.M., Smith V.E., Rautaharju P.M. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) //Am J Cardiol. 1994. 74. P. 236-241.
15. Influence of heart rate on mortality among persons with hypertension: The Framingham study / Gillman M., Kannel W., Belanger A. [et al.] //Am Heart J. 1993. 125. P. 1148-1154
16. Chronic kidney disease as an independent risk factor for new-onset atrial fibrillation in hypertensive patients / Horio T., Iwashima Y., Kamide K., Tokudome T., Yoshihara F., Nakamura S. [et al.]. J Hypertens. 2010. 28. 1738-1744.
17. Relation of atrial fibrillation to glomerular filtration rate. / Iguchi Y., Kimura K., Kobayashi K., Aoki J., Terasawa Y., Sakai K. [et al.] //Am J Cardiol. 2008. 102. 1056-1059.
18. Aortic Stiffness in Lone Atrial Fibrillation: A Novel Risk Factor for Arrhythmia Recurrence / Lau D.H., Middeldorp M.E., Brooks A.G. [et al.]. PLoS ONE. 2013. 8(10). P. e76776.
19. Expert consensus document on arterial stiffness: metodological issues and clinical applications / Laurent S., Cockcroft J., Van Bortel L. [et al.] //Eur Heart J. 2006. 27. P. 2588-2605.
20. CHADS2 and CHA2DS2-VASc scores as predictors of left atrial ablation outcomes for paroxysmal atrial fibrillation / Letsas K.P., Efremidis M., Giannopoulos G. [et al.]. Europace. 2014. V. 16. P. 202-207.
21. ESH/ESC Guidelines for the management of arterial hypertension / Mancia G., Fagard R. [et al.]. European Heart Journal. 2013. V. 34. P. 2159-2219.
22. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document / Mancia G., Laurent S., Agabiti-Rosei E. [et al.] //J Hypertens. 2009. V. 27. P. 2121-2125.
23. Messerli F.H., Mancia G., Conti C.R., Hewkin A.C., Kupfer S., Champion A., Kolloch R.Benetos A., Pepine C.J. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? //Ann Intern Med. 2006. V. 144. P. 884-893.
24. Nagarakanti R., Ezekowitz M. Diastolic dysfunction and atrial fibrillation.. J Interv CardElectrophysiol. 2008. V. 22(2). P. 111-118.
25. Impact of Chronic Kidney Disease on Risk of Incident Atrial Fibrillation and Subsequent Survival in Medicare Patients / Nelson S.E., Shroff G.R., Shuling Li [et al.] //J Am Heart Assoc. 2012. V. 1. P. e002097 doi: 10.1161/ JAHA.112.002097
26. Park B.J., Lee H.R., Shim J.Y., Lee J.H., Jung D.H., Lee Y.J. Association between resting heart rate and arterial stiffness in Korean adults. Arch Cardiovasc Dis. 2010. V. 103. P. 246-252.
27. Pastor-Barriuso R., Banegas J.R., Damian J., Appel L.J., Guallar E. Systolic blood pressure, diastolic blood pressure, and pulse pressure: an evaluation of their joint effect on mortality. Ann Intern Med. V. 139. P. 731-739.
28. Reiffel J.A.Is arterial stiffness a contributing factor to atrial fibrillation in patients with hypertension? A preliminary investigation //Am J Hypertens. 2004. V. 17(3). P. 213-216.
29. Association between high heart rate and high arterial rigidity in normotensive and hypertensive subjects / Sa Cunha R., Pannier B., Benetos A. [et al.] //J Hypertens. 1997. V. 15. P. 1423-1430.
30. Evolution of parameters of arterial distensibility in a cohort of young-to-middle-age hypertensive subjects / Saladini F., Benetti E., Mos L. [et al.]. J Hypertens. 2010. V. 28. P. e176.
31. Sang-Hak Lee, Seonghoon Choi, Jae-Hun Jung, Namho Lee. Effects of Atrial Fibrillation on Arterial Stiffness in Patients With Hypertension. Sage journals.. Angiology. URL: http://ang.sagepub.com/content/59/4/459.abstract
32. Shlomai G, Grassi G, Grossman E., Mancia G. Assessment of Target Organ Damage in the Evaluation and Follow-Up of Hypertensive Patients: Where Do We Stand?. The Journal of Clinical Hypertension. 2013. V. 15 (10). P. 742-747.
33. Spach M.S., Heidlage J.F., Dolber P.C., Barr R.C. Mechanism of origin of conduction disturbances in aging human atrial bundles: experimental and model study. Heart Rhythm. 2007. V. 4. P. 175-185.
34. Disturbed Left Atrial Function is Associated with Paroxysmal Atrial Fibrillation in Hypertension. / Tenekecioglu E., Vatansever A.F., Ozluk O.A. [et al.]. Arq Bras Cardiol. 2013.
35. baPWV/cfPWV Collaboration Group. Synergistic relationship between changes in the pulse wave velocity and changes in the heart rate in middle-aged Japanese adults: a prospective study / Tomiyama H., Hashimoto H., Tanaka H. [et al.]. J Hypertens. 2010. V. 28. P. 687-694.
36. Prediction of cardiovascular events and all-cause mortality with central haemodinamics: a systematic review and meta-analysis / Vlachopoulos C., Aznaoridis K., O´rourke MF [et al.]. Eur Heart J. 2010. V. 31. P. 1865-1871.
37. Association among blood pressure control in elderly patients with hypertension, left atrial structure and function and new-onset atrial fibrillation: a prospective 2-year study in 234 patients / Watanabe T., Kawasaki M., Tanaka R. [et al.]. Hypertension Research. 2013. V. 36. P. 799-806.
38. Zanchetti A. Blood pressure targets of antihypertensive treatment: up and down the J-shaped curve. Eur Heart J. 2010. V. 31. P. 2837-2840.
39. Interplay between arterial stiffness and diastolic function: a marker of ventricular-vascular coupling / Zito C., Mohammed M., Todaro M.C. [et al.]. J Cardiovasc Med (Hagerstown). 2014. V. 15(11). P. 788-796.
