af an under recognized manifestations of resistant hypertension

Paroxysmal AF: An Under recognized manifestation

of Resistant Hypertension

Dr. Ulhas M. Pandurangi

Chief: Cardiac Electrophysiology & Pacing

Arrhythmia Heart Failure AcademyThe Madras Medical Mission

Annual Summit of Hypertension - 2014

22nd June 2014

Atrial Fibrillation

COMMONEST ARRHYTHMIA

COMMON CAUSE OF STROKE

AF + STROKE = POOR PROGNOSIS

MANAGEMENT - CHALLENGING

Precipitating factors of AF

SYMPATHETIC STIMULANTS

CAFFEINE / ALCOHOL

EXERCISE

ISCHEMIA

HEART FAILURE

HYPERTENSION

Surges in Blood Pressure trigger AF

Blood Pressure Surges

POORLY CONTROLLED HTN

INAPPROPRIATE DOSAGES

POOR COMPLIANCE

RESISTANT HYPERTENSION

Ideal Drug orCombination of drugs

for AF + HTN

NOT SPECIFICALLY STUDIED

ACEI / ARB / B-B / CaB / DIURETICS

AF ONSET COINCIDES WITH BP SURGE. HENCE, PREVENTING BP SURGES

REDUCE AF INCIDENCE

Management of Resistant Hypertension

Ambulatory BP monitoring is strongly recommended

Management of Resistant Hypertension

‘Sleeker’, Digital HR and BP trends display

Only the BP trends do not help much !

AF onset coincides with BP surge

160

100

60

Case Study

68 years old Male

Hypertension – 9 years

S/P PTCA – 4 years

TIA – 3 years

Paroxysmal AF – 2 years

Recurrent Palpitations – 6 months

Office BP Measurements

February 2011 - 180/100 mmHg

June 2011 - 200/110 mmHg

December 2011 - 170/90 mmHg

Distressed by ‘frequent’ episodes of palpitations between November – December 2011

The Madras Medical Mission

Was Prescribed …Ambulatory BP monitoring in January

2012160

100

60

Medications Optimized

Telmisartan 80mg + Chlorthalidone 12.5mg

Metoprolol Succinate 100mg

Amlodipine 5mg

Frequency & Duration of Palpitations significantly

reduced

Follow UpAmbulatory BP monitoring in February

2012160

100

60

Last F/U – April 2014

Doing Well

Take Home Messages

Paroxysmal AF is an under recognized manifestation of resistant hypertension

BP surges trigger AF

Preventing BP surges by optimal antihypertensive therapy is strongly recommended

Thank You !

Annual Summit of Hypertension - 2014