Hypertension and Cardiac Comorbidities: A 3-Question Quiz

May 3, 2017
Gregory W. Rutecki, MD
Gregory W. Rutecki, MD

See what you know about optimal co-management when the patient with hypertension also has Afib, CAD, or heart failure.

In a recent article we looked at the treatment of hypertension in the context of chronic kidney disease. This time, let’s look at hypertension in persons who have comorbid heart disease, specifically atrial fibrillation (AF), coronary artery disease (CAD), and systolic heart failure. The quiz is a quick check on what you know about important principles of co-management.

What does AF have to do with high blood pressure?

In the Women’s Health Study, 34,221 women were followed for the development of incident AF.1 The cumulative incidence of AF increased across a continuum of rising blood pressures. The higher the blood pressure, even if it was not at a level requiring therapy, the higher the incidence of AF. Unfortunately, hypertension and AF often coexist and are synergistic in causing morbidity: hypertension is associated with left ventricular hypertrophy, impaired ventricular filling, left atrial enlargement, and slowing of atrial conduction velocity-all changes that are conducive to atrial arrhythmia.

1. Regarding the relationship of AF and hypertension, which of the following is/are true?A. When patients with AF are optimally anticoagulated, hypertension is still independently associated with a higher risk of stroke.

B. In recent clinical trials of direct oral anticoagulants (DOACs) enrolling AF patients, 80-90% of individuals with AF also had hypertension.

C. In patients with AF who are not anticoagulated, hypertension as a comorbidity does not affect the risk of stroke.

D. A and B

E. B and C


 

References:

1. Conen D, Tedrow UB, Koplan BA, et al. Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women. Circulation 2009; 119:2146-2152. http://circ.ahajournals.org/content/119/16/2146.long

2. Rao MP, Halvorsen S, Wojdyla D, et al. Blood pressure control and risk of stroke or systemic embolism in patients with atrial fibrillation: Results from the Apixaban for reduction in stroke and other thromboembolic events in Atrial Fibrillation (ARISTOTLE) Trial. J Am Heart Assoc. 2015; e002015 doi: 10.1161/JAHA. 115.002015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845276/

3. Rosendorff C. Treatment of hypertension in patients with coronary artery disease: A case-based summary of the 2015 AHA/ACC/ASH scientific statement. Am. J. Med 2016;129:372-378. https://www.ncbi.nlm.nih.gov/pubmed/?term=Am.+J.+Med+2016%3B+129%3A372-378.

4. Aronow WS. Current treatment of hypertension in patients with coronary artery disease recommended by different guidelines. Expert Opin Pharmacother. 2016 17:205-215. http://www.tandfonline.com/doi/abs/10.1517/14656566.2015.1091881?journalCode=ieop20

5. Carlberg B, Samuelson O, Lindholm LH. Atenolol in hypertension: is it a wise choice? Lancet. 2004;364:1684-1689. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17355-8/abstract