Are Some “Lone” Atrial Fibrillations Caused by Masked Hypertension?

To the Editor: We congratulate the authors of the paper titled “Masked Hypertension and Prehypertension: Diagnostic Overlap and Interrelationships With Left Ventricular Mass: The Masked Hypertension Study”, because it widens our understanding of masked arterial hypertension (MAHT).1 MAHT is prevalent and may be even more so: as home blood pressure (BP) measurement becomes more popular, the detection MAHT will increase. Ambulatory blood pressure monitoring is the best method for estimating an individual’s cardiovascular risk related to arterial hypertension (AHT).2 On the other hand, atrial fibrillation (AF) has every reason to be considered important: (i) it is prevalent—the most common chronic arrhythmia; (ii) AF prevalence is expected to grow—at least twice over the next 50 years; (iii) it increases mortality independently—death rates are doubled by AF; (iv) it raises morbidity, e.g., increases number of hospitalizations because of heart failure, substantially increases risk of stroke, etc.; (v) AF is symptomatic, sometimes more than stable angina; consequently, AF decreases quality of life; and (vi) it consumes a substantial amount of health care spending.3 AF is classified as “lone” if patient has no known cause of AF, e.g., AHT, left ventricular hypertrophy, etc. There are basically two types of MAHT: