Atrial Cardiomyopathy and Hypertension: Connections between Arterial Stiffness and Subclinical Atrial Arrhythmias

Systemic arterial hypertension (SAH) is the primary risk factor for cardiovascular disease, promoting activation of the renin-angiotensin-aldosterone system (RAAS), endothelial dysfunction, arterial stiffness, fibrosis, and myocardial hypertrophy. Prospective studies show that the consequences include left ventricular hypertrophy (LVH), left atrial (LA) overload, and a higher risk of atrial fibrillation (AF). In the classic Framingham study, hypertension was an independent predictor of AF and, on its own, accounted for more cases of this arrhythmia than any other risk factor.

The recognition of a “pre-AF” phase, where atrial functional changes have not yet translated into dilation or clinically manifest AF, is of utmost importance in modern cardiology, as early recognition allows for therapeutic interventions before the condition evolves into an established disease. Functional and structural changes in the LA are predictors of atrial arrhythmias during rhythm monitoring, and these, in turn, are predictors of a higher risk of AF.^,

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