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What do we actually know about the relationship between arterial hypertension and atrial fibrillation?

Abstract Arterial hypertension and atrial fibrillation (AF) are very prevalent cardiovascular diseases, commonly seen together. Considering the fact that frequency of these medical conditions is constantly increasing due to human life extension, AF will be one of the major risks of cardiovascular morbidity and mortality in the future. Several pathophysiological mechanisms have been proposed to explain the onset of AF in arterial hypertension, and there are numerous theories that explain the protective effect of renin–angiotensin–aldosterone system (RAAS) blockade on new-onset AF. However, the consensus on pathophysiology and the favorable effect of RAAS blockade on AF development is still missing. On the other hand, large clinical trials and meta-analyses demonstrated a positive effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on AF prevention, which is why these drugs are included in the current guidelines for arterial hypertension, and will probably be better positioned in the new guidelines, which will be published this year. The recent studies have also shown a preventive effect of other antihypertensive drugs on AF occurrence and demonstrated that aggressive approach to hypertensive patients with AF is very important not only for conversion into sinus rhythm, but also for sinus rhythm maintenance.