{'fraction_non_alphanumeric': 0.023614683189151275, 'fraction_numerical': 0.006780453588964227, 'mean_word_length': 5.3097345132743365, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Atrial Fibrillation and Hypertension: Do New Anticoagulants Change the Matter?

Atrial fibrillation (AF) is a relevant problem in hypertensive patients. Current guidelines for the management of patients with AF recommend that all hypertensive patients should receive therapy, oral anticoagulation in the great majority of cases, to prevent thromboembolic complications. The recent position paper of the Working Group ‘‘Hypertension Arrhythmias and Thrombosis’’ of the European Society of Hypertension indicates that vitamin K antagonists have been proven effective for more than 50 years and are the standard anticoagulation treatment for AF. However, as they indicate, they have important disadvantages that include their underutilization for different reasons and this translates into an increase of morbidity and mortality. On the other hand, the recent publication of important clinical trials such as the Randomized Evaluation of Long-Term Anticoagulant Therapy (Re-Ly), Rivaroxaban Once Daily Oral Direct Factor Xa Inhibitor Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (Rocket-AF), and Rivaroxaban Once Daily Oral Direct Factor Xa Inhibitor Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ARISTOTLE) that analyzed the new oral anticoagulant agents dabigatran, rivaroxaban, and apixaban, respectively, in nonvalvular AF patients, have shown promising results that may likely replace vitamin K antagonists. They have been shown to similarly or, even better, prevent new thromboembolic events, with lesser intracranial bleeding and with a better tolerability profile. Moreover, they do not require permanent monitoring. Dabigatran and rivaroxaban have been approved by both the Federal Drug Association and the European Medicines Evaluation Agency. Since most of the patients included in these outcome trials were hypertensive (79% in ReLy, 90% in Rocket-AF, and 87.5% in ARISTOTLE), the results obtained with these new drugs can be well applied to the hypertensive population. In light of these data, according to the Working group, the main problem of new oral anticoagulants is their cost, and, as a result, it is very important to select the candidates for the use of these new drugs in order to be cost-effective. However, other relevant issues should be taken into account before considering the use of classical or newer anticoagulants. Many studies have shown that anticoagulation is underused in patients with nonvalvular AF. Thus, in a recent study that included more than 9000 outpatients with nonvalvular AF who were at moderate to high risk for stroke, only 55.1% were taking warfarin. However, although important, the problem is not limited to the underuse of anticoagulation. In a recent study that included nearly 3300 patients with AF, of whom 92.6% had hypertension, despite the fact that more than two thirds of patients had a CHADS2 score 2, approximately one third of them were not taking anticoagulants. Nevertheless, about half of the patients with a CHADS2 score of 1 were receiving oral anticoagulants. Even more, almost half of the patients with CHADS2 score of 0 were also taking anticoagulant therapy. Thus, anticoagulation in nonvalvular AF, or more properly in nonvalvular hypertensive population, is not only underused but wrongly used. In this context, new oral anticoagulants that do not need monitoring and seem safer could lead to more appropriate use of anticoagulants in patients with AF. However, with the use of dabigatran in clinical practice, some warnings have been reported. In fact, the rate of bleeding is under investigation, which seems to be higher than those reported in the Re-Ly trial. These higher rates of bleeding could be associated with the use of dabigatran in patients in whom its use is not properly indicated. Therefore, more efforts should be made to improve the antithrombotic management of patients with AF. With regard to new anticoagulants, although the results of recent clinical trials are promising, special caution should be taken before their use, considering those patients who would benefit more with newer oral anticoagulants, following strictly the current recommendations for their use.