Hypertension, chronic kidney disease, atrial fibrillation and the newer anticoagulants

Abstract

Atrial fibrillation (AF) is a common clinical condition that is associated with increased morbidity and mortality that mainly relates to an embolic stroke. Dominant risk factors for AF are advanced age and hypertension in the absence of mitral valve disease.¹ In turn, hypertension and ageing are determinants of the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or transient ischaemic attack or thromboembolism (CHADS₂) criteria for assessing the indication for anticoagulation. In addition, they are important risk factors for chronic kidney disease (CKD). In itself, CKD is an independent risk factor for AF and a higher risk of stroke.² It is highly likely that a practitioner will encounter older patients with AF and concomitant hypertension and CKD that require anticoagulation therapy. Thus, it is essential for the practitioner to understand the risks and benefits of anticoagulation in older patients with AF, hypertension and CKD.