Effects of hypertension and atrial fibrillation on stroke risk

Background: Arterial hypertension and atrial fibrillation (AF) are among the most significant modifiable risk factors for stroke. Their coexistence markedly increases the risk of cerebrovascular events and cognitive decline. Even high-normal blood pressure is associated with a higher likelihood of developing AF, and optimal control of blood pressure can reduce this risk, particularly in high-risk patients. Objective: To summarize and critically analyze the relationship between arterial hypertension, atrial fibrillation, and stroke risk, with particular focus on prevention, early detection, and management strategies. Methods: A narrative literature review was performed using PubMed, Embase, Scopus, Web of Science, and the Cochrane Library, along with the latest European Society of Cardiology (ESC) guidelines on hypertension and AF. The search covered publications from the last 10 years, using terms including “hypertension”, “atrial fibrillation”, “stroke risk”, and “prevention”. Inclusion criteria comprised clinical trials, population-based studies, systematic reviews, and major guidelines concerning adult populations. Studies with insufficient methodological data or involving non-human subjects were excluded. Results: Population-based studies indicate that high-normal blood pressure increases the risk of developing AF by up to 60%, while the coexistence of hypertension and AF increases stroke risk more than fivefold compared to individuals without either factor [8]. Effective AF management should be comprehensive, such as the CARE model, and include early initiation of anticoagulation guided by the CHA₂DS₂-VASc score rather than arrhythmia type alone. Evidence supports the role of NOACs and catheter ablation in selected patients, although comparative advantages over pharmacological therapy are inconsistent. Early detection of silent AF in hypertensive patients and those with cryptogenic stroke is a key element of secondary prevention. Multi-domain lifestyle interventions, including dietary modification and physical activity, further reduce cardiovascular and cerebrovascular risk. Conclusions: Current evidence supports ESC guidelines emphasizing strict blood pressure control and comprehensive AF management as central components of stroke prevention. Identified knowledge gaps include insufficient data on optimal BP targets for AF prevention, limited evidence on the combined effect of intensive BP control and anticoagulation, and a lack of large-scale trials assessing early detection strategies for silent AF in hypertensive patients. Addressing these gaps could improve prevention strategies and reduce stroke incidence.