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Targeting the renin–angiotensin–aldosterone system in atrial fibrillation: from pathophysiology to clinical trials

Journal of Human Hypertension volume 19, pages 855–859 (2005)Cite this article

Atrial fibrillation (AF) represents a serious and escalating health problem. Not only is it the most common sustained cardiac arrhythmia, but given an ageing population and improved survival of patients with cardiovascular disease (CVD), its prevalence is increasing.1 This is important, because the presence of AF increases mortality, morbidity and adversely affects quality of life.1 There is therefore the need for improved AF prevention measures targeting individuals at high risk of future arrhythmia, as well safer yet effective rhythm control strategies.

On a population basis, hypertension is the commonest aetiological factor for AF.2 This is in contrast to studies based on hospital admissions, where ischaemic heart disease is the commonest aetiological factor.1 More importantly, both hypertension and AF are individually risk factors for stroke, and the risk is even greater if both are present in combination, especially in the presence of diabetes mellitus and/or heart failure.3 The presence of hypertension, per se, increases the risk of stroke in AF by nearly two-fold. Hypertension may lead to AF via left atrial dilatation, ischaemia and/or increased intra-atrial pressure consequent upon reduced left ventricular compliance, especially in the setting of hypertensive left ventricular hypertrophy (LVH).3 Hypertension may also lead to coronary artery disease, and AF is common following myocardial infarction and the frequently associated left ventricular dysfunction.3 Finally, alcohol can lead to both hypertension and AF.

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  1. University Department of Medicine, Haemostasis, Thrombosis and Vascular Biology Unit, City Hospital, Birmingham, UK

    C J Boos & G Y H Lip

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Boos, C., Lip, G. Targeting the renin–angiotensin–aldosterone system in atrial fibrillation: from pathophysiology to clinical trials. J Hum Hypertens 19, 855–859 (2005). https://doi.org/10.1038/sj.jhh.1001933

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