Essential Hypertension Significantly Associated With Atrial Myopathy, Stroke Risk

Essential hypertension (EHT) is heavily associated with atrial myopathy (AM), which in turn can contribute to ischemic stroke before the onset of atrial fibrillation (AF), according to a recent study.¹

Presented at the European Society of Cardiology (ESC) Congress 2026 in Munich, Germany, by Andriany Qanitha, MD, MSc, PhD, associate professor in the department of physiology and the department of cardiology and vascular medicine at Hasanuddin University in Indonesia, and colleagues, this study aims to fill the gap in evidence discussing EHT’s association with stroke risk across all stages of AF progression.¹

“Essential hypertension (EHT), a highly prevalent and modifiable risk factor, may promote AM by impairing left atrial (LA) structure and function,” Qanitha and colleagues wrote. “However, data evaluating the contribution of EHT to AM across AF progression stages using LA functional parameters remain limited.”¹

EHT is a chronic elevation of blood pressure that affects almost 95% of all hypertensive patients. While its etiology is not known, genetics are believed to account for roughly 50% of all EHT cases. EHT is also usually asymptomatic, leaving many patients unaware of the disease or its potential status as a risk factor for AF and, eventually, stroke.²

Qanitha and colleagues conducted a 5-year cross-sectional study, stratifying patients according to AF progression stages in accordance with the 2023 ACC/AHA/ACCP/HRS AF treatment guidelines. These stages included Stage 1 (at risk for AF without stroke; n = 140), Stage 2 (pre-AF with stroke; n = 187), Stage 3 (paroxysmal AF with stroke; n = 102), and Stage 4 (permanent AF with stroke; n = 72). The trial also included 102 healthy controls. The team assessed left atrial reservoir strain (ReSt), global longitudinal strain (GLS), and LA emptying fraction (LAEF) using velocity vector imaging echocardiography. Possible associations between risk factors and AF stages were analyzed with multivariable logistic regression.¹

A total of 603 patients were ultimately included in the study, with a mean age of 62.5 +/- 12.5 years. EHT was prevalent (70.3%) and remained the primary risk factor across all 4 AF stages (77.3%, 90.9%, 91.2%, and 75% in Stages 1-4, respectively). Additionally, multivariable analysis identified EHT (OR, 6.59; 95% CI, 3.63-11.98), LAEF <35% (OR, 3.05; 95% CI, 1.17-7.99), reduced LA ReSt (OR, 0.89; 95% CI, 0.84-0.94), and impaired GLS (OR, 0.9; 95% CI< 0.81-0.99) as independent predictors of ischemic stroke.¹

Ultimately, Qanitha and colleagues confirmed that EHT bears a significant association with not only atrial myopathy across AF stages, but through this connection may be a functional predictor of ischemic stroke.¹

“Essential hypertension is strongly associated with progressive atrial myopathy across AF stages and independently predicts ischemic stroke,” Qanitha and colleagues wrote. “Assessment of LA function using echocardiographic strain imaging may improve early risk stratification in hypertensive patients, even before overt atrial fibrillation develops.”¹

References

1: Qanitha A, Oemar H, Rilianto B, et al. Unmasking the Silent Threat: Essential Hypertension as a Catalyst for Ischemic Stroke Through Atrial Myopathy. Presented at the European Society of Cardiology Congress 2026, Munich, Germany. August 28-31, 2026.

2: Chen S. Essential hypertension: perspectives and future directions. J Hypertens. 2012;30(1):42-45. doi:10.1097/HJH.0b013e32834ee23c