Paroxysmal AF: An Under recognized manifestation of Resistant Hypertension Dr. Ulhas M. Pandurangi Chief: Cardiac Electrophysiology & Pacing Arrhythmia Heart Failure Academy The Madras Medical Mission Annual Summit of Hypertension - 2014 22 nd June 2014
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Af an under recognized manifestations of resistant hypertension
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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