Hypertension and Cardiac Arrhythmias

Arterial hypertension is a widespread disease and one of important yet under-recognized and under-treated causes of atrial and ventricular arrhythmias. Hypertrophy of cardiac muscle in hypertensive patients is characterized not only by increased myocardial mass, but also by proliferation of fibrous tissue and decreased intercellular coupling, that lead to inhomogeneity of electrical properties and propensity to various arrhythmias. Many trials show the importance of treating hypertension in order to restore normal myocardial function and decrease the number of premature beats, runs of ventricular tachycardia, and attacks of atrial fibrillation. To date, the most convincing data are collected regarding the importance of blockade of renin-angiotensin-aldosterone system (RAAS) in order to avoid arrhythmias in arterial hypertension. Other antihypertensive drug classes (eg beta-blockers, calcium antagonists) are also useful, and investigational compounds that aim at regression of hypertrophy are under search. Polymorphism of genes coding the function of RAAS, pathways of synthesis and degradation of proteins and other cardiac and extracardiac systems involved in regulation of blood pressure, are recognized as promising targets for research.