I'm Melissa Brown. I'm a cardiac electrophysiology physician assistant at Emory University, and I'm going to be talking today about hypertensive management with atrial fibrillation. I have no relevant financial disclosures. Hypertension is a major risk factor for atrial fibrillation, contributing to both structural and electrical remodeling in the atria. Hypertensive patients are at higher risk for developing atrial fibrillation due to increased left atrial pressure, fibrosis, and atrial dilation. Increased sympathetic tone in hypertensive patients destabilizes the atrial electrophysiology and can promote atrial fibrillation initiation as well. The 2023 AFib guidelines emphasize the importance of managing hypertension to prevent AFib and its complications. Early blood pressure control is essential to reduce the risk of atrial fibrillation as evidenced by the AHRQ study. A goal systolic blood pressure of less than 130 millimeters mercury is recommended to lower the AFib incidence and progression. The PATHWAY-2 trial demonstrated the benefit of spironolactone for managing resistant hypertension, which may help reduce the risk of AFib in hypertensive patients. The 2023 AFib guidelines recommend aggressive blood pressure management for patients with hypertension to prevent AFib and related complications, including stroke. Once AFib has developed, risk management and blood pressure control remain important. Beta-blockers, acin-ARBs, and calcium channel blockers are commonly used for both blood pressure control and rhythm management. In patients with resistant hypertension and AFib, spironolactone has shown positive effects as seen in the PATHWAY-2 trial. Here's some key clinical trials. Once again, the AHRQ study found that well-controlled blood pressure, particularly systolic blood pressure less than 130, significantly reduces the risk of AFib in middle-age and older adults. The PATHWAY-2 trial again demonstrated that spironolactone effectively manages resistant hypertension and can improve outcomes in AFib patients. The FIRM trial, while not directly focused on hypertension, this trial did show that controlling blood pressure in AFib patients helps improve long-term rhythm control and also reduces stroke risk. The ERATICA-AF trial showed that renal denervation combined with catheter ablation significantly reduced AFib recurrence in hypertensive patients. In conclusion, hypertension is a key risk factor for atrial fibrillation development and its complications, with significant evidence from the trials supporting aggressive blood pressure management, giving it a class one recommendation in the 2023 guidelines. Thank you.

hypertension

atrial fibrillation

blood pressure control

spironolactone

AFib guidelines