Hypertension and Atrial Fibrillation: A Frontier Review From the AF-SCREEN International Collaboration
Abstract
Hypertension is the leading modifiable risk factor for atrial fibrillation (AF) and is estimated to be present in >70% of AF patients. This Frontiers Review was prepared by 29 expert members of the AF-SCREEN International Collaboration to summarize existing evidence and knowledge gaps on links between hypertension, AF, and their cardiovascular sequelae; simultaneous screening for hypertension and AF; and the prevention of AF through antihypertensive therapy. Hypertension and AF are inextricably connected. Both are easily diagnosed, often silent, and frequently treated inadequately. Together, they additively increase the risk of ischemic stroke, heart failure, and many types of dementia, resulting in greater all-cause mortality, considerable disease burden, and increased health care expenditures. Automated upper arm cuff blood pressure devices with implemented technology can be used to simultaneously detect both hypertension and AF. However, positive screening for AF with an oscillometric blood pressure monitor still requires ECG confirmation. The current evidence suggests that high-risk individuals aged ≥65 years or with treatment-resistant hypertension could benefit from AF screening. Since antihypertensive therapy effectively lowers AF risk, particularly in individuals with left ventricular dysfunction, hypertension should be the key target for AF prediction and prevention rather than merely a comorbidity of AF. Nevertheless, several important gaps in knowledge need to be filled over the next years, including the ideal method and selection of patients for simultaneous screening of hypertension and AF and the optimal antihypertensive drug class and blood pressure targets for AF prevention.
Article Details
Authors (29)
Teemu J. Niiranen
Department of Internal Medicine, University of Turku, Turku, Finland (T.J.N.).
Renate B. Schnabel
Aletta E. Schutte
Yitschak Biton
Heart Institute, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (Y.B.).
Giuseppe Boriani
Claire Buckley
School of Public Health, University College Cork, Cork Ireland (C.B.).
Alan C. Cameron
School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK (A.C.C.).
Albertino Damasceno
Søren Z. Diederichsen
Wolfram Doehner
Yutao Guo
F.D. Richard Hobbs
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
Boyoung Joung
Yonsei University, Seoul, Korea (the Republic of)
Graeme J. Hankey
Gregory Y.H. Lip
Trudie Lobban
Maja-Lisa Løchen
Georges Mairesse
Department of Cardiology, Cliniques du Sud Luxembourg, Arlon, Belgium (G.M.).
Amam Mbakwem
Department of Medicine, College of Medicine, University of Lagos, Nigeria (A.M.).
Peter A. Noseworthy
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N.).
George Ntaios
Steven Steinhubl
Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN (S.S.).
George Stergiou
Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (G.S.).
Jesper Hastrup Svendsen
Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark (S.Z.D., J.H.S.).
Robert G. Tieleman
Department of Cardiology, Martini Hospital Groningen, Groningen, the Netherlands (R.G.T.).
Jiguang Wang
Division of Life Science, The Hong Kong University of Science and Technology
Neil R. Poulter
Imperial Clinical Trials Unit, Imperial College London, London
Jeff S. Healey
Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
Ben Freedman
Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, The University of Sydney, Sydney, NSW, Australia (B.F.).