2012, Number 2
<< Back Next >>
CorSalud 2012; 4 (2)
Risk of arrhythmias and hypertension
Chávez GE, Carmona PR
Language: Spanish
References: 28
Page: 130-135
PDF size: 175.98 Kb.
ABSTRACT
The higher prevalence of atrial fibrillation is doubled in patients with hypertensive heart disease. In the Framingham study, the following risk factors were found: hypertension, maximum P wave duration and dispersion of the electrocardiogram, atrial size and left ventricular mass. The renin-angiotensin-aldosterone system is responsible for the inflammation and the structural changes that justify the development of arrhythmias in hypertensive patients. The presence of ventricular arrhythmias, from premature ventricular complexes to ventricular tachycardia, has been shown in a 10 to 27% of affected patients, a percentage that decreases with the severity of the arrhythmia. Noninvasive risk markers for ventricular arrhythmias have been summarized as follows: dispersion and variability of the QT interval, presence of late potentials, heart rate variability, abnormal morphology and T-wave alternans. All of these are related to anatomic-structural changes of the ventricular wall, which affect the action potential. The importance of knowing the epidemiology, pathophysiology, and noninvasive risk markers for arrhythmias in hypertensive patients, offers a way for the application of the proper therapeutic in the control of blood pressure and regression of hypertrophy, as has been shown by inhibitor drugs of the renin-angiotensin-aldosterone system, which decrease the risk of arrhythmias.
REFERENCES
Fatkin D, Otway R, Vandenberg JI. Genes and Atrial Fibrillation: A New Look at an Old Problem. Circulation. 2007;116(7);782-92.
Anter E, Callans DJ, Wyse DG. Pharmacological and Electrical Conversion of Atrial Fibrillation to Sinus Rhythm Is Worth the Effort. Circulation. 2009;120(14):1436-43.
Lombardi F. Inhibidores ECA y FA. Procedente del 3er Simposio Internacional de Fibrilación Auricular [Internet];30 Oct 2009 [citado 8 Oct 2009]. Dispo-nible en: http://www.af-ymposium.org
Hipertensión arterial, arritmias y muerte súbita [Internet]. 2001 [citado 5 Ene 2009]. Disponible en: http://www.medynet.com/elmedico/publicaciones/sistole238/24-26.pdf
Ebergel E, Chatellier G, Battaglia G, Menard J. ¿Puede la ecocardiografía identificar pacientes hipertensos leves de alto riesgo, dejados sin tratar, basados en las actuales guías? J Hypertension. 1999;17(6):817-24.
Kannel WB, Wolf PA, Benjamin EJ, Levy D. Pre-valence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82(8A):2N-9N.
Messerli FH, Ventura HO, Elizardi DG, Dunn FG, Frohlich ED. Hypertension and sudden death. In-creased ventricular ectopic activity in left ventricular hypertrophy. Am J Med. 1984;77(1):18-22.
Yiu KH, Tse HF. Hypertension and cardiac arrhyth-mias: a review of the epidemiology, pathophysiology and clinical implications. J Hum Hypertens. 2008;22 (6):380-8.
Bayes de Luna AJ. Activación auricular. Asa de P. En: Electrocardiografía clínica. Madrid: Harcourt Brace; 1995. p. 20.
Del Corral Beamonte E, Fleta Asín B, Martínez Moya L, García Noain A, Gonzalvo Liarte MA, et al. Hipertensión arterial, un antecedente frecuente en los pacientes con fibrilación auricular. Comunica-ciones. 9 a Reunión Nacional SEH-LELHA. 2004. Disponible en: http://www.doyma.es/hipertensión
Chávez González E, González Rodríguez E, Car-mona Puerta R, Ramos Ramírez R. Arritmias en el paciente hipertenso: ¿cómo prevenirlas? Medicen-tro Electrónica [Internet]. 2010 [citado 7 Sept 2011]. Disponible en: http://medicentro.vcl.sld.cu/paginas%20de%20acceso/Sumario/ano%202010/v14n3a10/001arritmias56.htm
Vázquez Álvarez J, Herrero Puente P, Marín R, Fernández Vega F, Prieto M, Hevia A. Hipertensión arterial y fibrilación auricular: una asociación olvi-dada [CD-ROM]. Comunicaciones. 9na Reunión Nacional SEH-LELHA. Murcia: Elsevier; 2004.
Ozer N, Aytemir K, Atalar E, Sade E, Aksöyek S, Ovünç K, et al. P wave dispersion in hypertensive patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;(11 Pt 2):1859-62.
Ravn LS, Aizawa Y, Polevick GD, Hofman-Bang J, Cordeiro JM, Dixen U, et al. Gain of function IKs secondary to a mutation in KCNE5 associated with atrial fibrillation. Heart Rhythm. 2008;5(3):427-34.
Kosar F, Aksoy Y, Ari F, Keskin L, Sahin I. P-wave duration and dispersion in obese subjects. Ann Noninvasive Electrocardiol. 2008; 13(1):3-7.
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. JACC. 2006;48(4):854-906.
Moro Serrano C, Hernández-Madrid A. Fibrilación auricular: ¿estamos ante una epidemia? Rev Esp Cardiol. 2009;62:10-4.
Bumpus FM. Angiotensin I and II. Some early ob-servations made at the Cleveland Clinic Foundation and recent discoveries relative to angiotensin II formation in human heart. Hypertension. 1991;18(5 Suppl):III122-5.
Edwin K, Garrison JC. Renina y angiotensina. En: Goodman & Gilman. Las bases farmacológicas de la terapéutica médica. Vol. 2. Traducido de la 9na ed en inglés. México DF: McGraw-Hill; 1996. p. 791-93.
Márquez MF, Gómez-Flores J, Aranda-Faustro A, Cazares-Campos I, Cárdenas M. Avances recientes en la fisiopatología de la fibrilación auricular. Arch Cardiol Mex. 2009;79(Supl. 2):18-25.
Guo D, Young L, Wu Y, Belardinelli L, Kowey PR, Yan GX. Increased late sodium current in left atrial myocytes of rabbits with left ventricular hypertrophy: its role in the genesis of atrial arrhythmias. Am J Physiol Heart Circ Physiol. 2010; 298(5):H1375-H81.
Yildirir A, Batur MK, Oto A. Hypertension and arrhythmia: blood pressure control and beyond. Europace. 2002;4(2):175-82.
Chávez González E, Castro Hevia J, González Ro-dríguez E. Dispersión de la Onda P en el electro-cardiograma con bases en el potencial de acción auricular y en la heterogeneidad del impulso en aurículas. Relampa. 2010;23(3):126-33.
Kannel WB, Abbot RD. A prognostic comparison of asymptomatic left ventricular hypertrophy and un-recognized myocardial infarction: the Framingham Study. Am Heart J. 1986;111(2):391-7.
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardio-graphically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990; 322:1561-6.
Bendersky M, Piskorz D, Boccardo D. Cardiopatía hipertensiva. Rev Fed Arg Cardiol. 2002;31:321-4.
Hennersdorf MG, Niebch V, Perings Ch, Strauer BE. T Wave Alternans and Ventricular Arrhythmias in Arterial Hypertension. Hypertension 2001;37(2); 199-203.
Serra JL, Bendersky M. Fibrilación auricular y sistema renina-angiotensina. Rev Fed Arg Cardiol. 2009;38:123-31. CorSalud