Hypertension and Atrial Fibrillation: A Frontier Review From the AF-SCREEN International Collaboration

Area of Science:

• Cardiology
• Hypertension Research
• Atrial Fibrillation Studies

Background:

• Hypertension is the primary modifiable risk factor for atrial fibrillation (AF), affecting over 70% of AF patients.
• Hypertension and AF are often undiagnosed and undertreated, significantly increasing risks of stroke, heart failure, dementia, and mortality.

Purpose of the Study:

• To review evidence on the links between hypertension, AF, and cardiovascular outcomes.
• To explore simultaneous screening for hypertension and AF.
• To assess AF prevention through antihypertensive therapy.

Main Methods:

• Expert review by 29 members of the AF-SCREEN International Collaboration.
• Synthesis of existing evidence and identification of knowledge gaps.
• Analysis of automated blood pressure devices for simultaneous hypertension and AF detection.

Main Results:

• Hypertension and AF are closely linked, with combined effects amplifying risks of major cardiovascular events and mortality.
• Automated blood pressure devices show potential for simultaneous hypertension and AF screening, requiring ECG confirmation for AF.
• Antihypertensive therapy is effective in reducing AF risk, especially in patients with left ventricular dysfunction.

Conclusions:

• Hypertension should be a primary target for AF prediction and prevention, not just a comorbidity.
• High-risk individuals (≥65 years, treatment-resistant hypertension) may benefit from AF screening.
• Further research is needed on optimal screening methods, patient selection, antihypertensive drug classes, and blood pressure targets for AF prevention.