title: Restoring sinus rhythm results in blood pressure reduction in patients with persistent atrial fibrillation and a history of hypertension.
abstract: BACKGROUND
  The long-term effects of atrial fibrillation (AF) on blood pressure (BP) in patients with hypertension (HTN) remain unclear. We hypothesized that restoration of normal sinus rhythm (NSR) results in a decrease in BP despite the expected increase in cardiac output.
  
  
  RESULTS
  Twenty-four-hour BP measurements were obtained during AF, and on Day 1 and Day 30 post-successful cardioversion in 18 patients with AF and HTN (cardioversion group), and another 22 patients with AF and HTN with no immediate plans for cardioversion (control group). Except for the duration of AF, the clinical characteristics and use of medications were similar between the groups. In the cardioversion group, a significant decrease in diastolic blood pressure (DBP) and mean blood pressure (MBP) were noted on Day 1 post-cardioversion with no significant change in systolic blood pressure (SBP): 117/74/88 ± 13/9/9 mmHg during AF and 116/70/85 ± 13/9/10 mmHg during Day 1 post-cardioversion (P = 0.68; <0.01 and 0.04 for SBP, DBP, and MBP, respectively). In the 13 subjects who remained in NSR at Day 30, DBP and MBP decreased further on Day 30 when compared to Day 1 with no significant change in SBP: 118/76/90 ± 13/7/8 mmHg during AF; 119/72/88 ± 12/8/9 mmHg during Day 1; and 118/69/86 ± 10/8/7 mmHg during Day 30 post-cardioversion (P = 0.97; <0.001 and 0.03 for SBP, DBP, and MBP, respectively). In the control group, no significant changes in BP were noted.
  
  
  CONCLUSIONS
  Restoring NSR in patients with AF and HTN resulted in a sustained decrease in DBP and MBP. To our knowledge, this is the first study to show that maintenance of NSR improves BP control in patients with AF and HTN.
authors.affiliation: Division of Geriatrics, University of Utah, Medical Center, Salt Lake City, Utah 84132, USA.
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Sanders
authors.forename: Cristina
authors.initials: C
authors.lastname: Bertolone
authors.forename: Tawni L
authors.initials: TL
authors.lastname: Jetter
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Wasmund
authors.forename: Francesco
authors.initials: F
authors.lastname: Croci
authors.forename: Alberto
authors.initials: A
authors.lastname: Solano
authors.forename: Michele
authors.initials: M
authors.lastname: Brignole
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Hamdan
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D002302:Cardiac Output; D016022:Case-Control Studies; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome; D014589:Utah
chemical_list: D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents