Harvard Heart Letter

Heart Beat: Atrial fibrillation and blood pressure

Atrial fibrillation is a fast, irregular beat in the atria, the two upper chambers of the heart. It can cause symptoms such as shortness of breath and fatigue. It can also lead to stroke. That's because the inefficient contractions of the atria have trouble pushing blood down into the ventricles. This allows blood to linger inside the atria, which sets the stage for the formation of stroke-causing blood clots. Taking warfarin (Coumadin, Jantoven, generic) or another blood thinner to prevent clots is a keystone of treating atrial fibrillation.

Blood pressure control should also be at the heart of stroke prevention efforts. In a large international trial among people with type 2 diabetes, the payoff for aggressive blood pressure control was greater for people with atrial fibrillation — in terms of fewer deaths from stroke and other cardiovascular causes — than it was among those without this problem (European Heart Journal, published online on March 11, 2009).

Although the best regimen for controlling blood pressure in people with atrial fibrillation is still under investigation, medications should probably include a diuretic and an ACE inhibitor or angiotensin-receptor blocker. People with diabetes or kidney disease should aim for a blood pressure under 130/80; the target for everyone else is under 140/90.

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