Atrial Fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and its prevalence increases markedly with advancing age, worldwide. Almost every primary care physician, internist, or cardiologist, has dealt with stroke or with other complications of AF. Still, its management remains a hot issue for clinicians and the debate over which treatment strategy is the best is ongoing. Moreover, AF increases significantly the total cardiovascular (CV) morbidity and mortality. Despite a great bulk of data in the existing medical literature, the pathophysiology of AF in patients with hypertensive heart disease (HHD) is poorly understood, and the underlying signaling pathways linking hypertension (HTN) to AF remain to be fully elucidated. The scope of this article is to discuss the myocardial anatomical and physiological alterations that occur in HTN, and highlight the proposed electrophysiological mechanisms that cause the hypertensive heart to fibrillate. In addition, we will focus on the latest ESC 2016 guidelines for the risk stratification of AF patients as a tool to guide anticoagulation which represents the mainstay of treatment for AF. Last, the other therapeutic approaches for hypertensives with AF currently adopted for optimal patient management will be reviewed.