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Editorial
Better blood pressure control in patients with atrial fibrillation: overcoming barriers to improve outcomes
  1. Mikhail S Dzeshka1,
  2. Alena Shantsila2,
  3. Eduard Shantsila2,3,
  4. Gregory Y H Lip2,4
  1. 1 Department of Internal Medicine I, Grodno State Medical University, Grodno, Belarus
  2. 2 Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
  3. 3 Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
  4. 4 Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  1. Correspondence to Dr Mikhail S Dzeshka, Department of Internal Medicine I, Grodno State Medical University, Grodno 230009, Belarus; mikhail.dzeshka{at}grsmu.by

https://doi.org/10.1136/heartjnl-2023-323028

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    Hypertension is the single most important risk factor for development of atrial fibrillation (AF), which may be considered as a cardiac manifestation of hypertensive target organ damage. Furthermore, coexistence of hypertension and AF mutually amplifies the risk of complications, such as heart failure and stroke.1 Hypertension results in structural changes in the heart, facilitated by the haemodynamic disturbances, autonomic dysregulation, atrial myocardial cellular injury with apoptosis and activation of profibrotic signalling pathways. These structural changes occur and progress as a result of prolonged exposure to risk factors with more electrical heterogeneity across the atria and arrhythmogenic substrate in patients with longer hypertension history and poor blood pressure (BP) control. Once AF is initiated, the arrhythmia itself can further stimulate above pathways, creating a vicious cycle that allows arrhythmia perpetuation and progression from paroxysmal to non-paroxysmal types.1

    By preventing or reversing the adverse cardiac remodelling processes through good BP control, it may be possible to interrupt the cycle of AF perpetuation and progression, leading to improved outcomes in patients with AF.1 Therefore, management of cardiovascular risk factors and comorbidities (also defined as upstream therapy) remains a paramount component of contemporary AF management, which has moved towards a more holistic or integrated care approach to management of patients with AF, summarised as the Atrial fibrillation Better Care (ABC) pathway. The latter refers to avoiding stroke with anticoagulation for ‘A’; better symptom control with patient-centred symptom-directed decisions on rate or rhythm control strategy for ‘B’; and cardiovascular risk and comorbidities management, including lifestyle changes for ‘С’. The ABC pathway serves as a framework for healthcare professionals to guide their decision-making and is recommended by guidelines.2 3 Adherence to the ABC pathway led to a major reduction in adverse events in patients with AF, including mortality, stroke/thromboembolism, bleeding and major …

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    Footnotes

    • Contributors All authors listed have made a substantial, direct and intellectual contribution to the work and approved it for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests GYHL: consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are received personally.

    • Provenance and peer review Commissioned; internally peer reviewed.

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