Niiranen Teemu J, Schnabel Renate B, Schutte Aletta E, Biton Yitschak, Boriani Giuseppe, Buckley Claire, Cameron Alan C, Damasceno Albertino, Diederichsen Søren Z, Doehner Wolfram, Guo Yutao, Hobbs F D Richard, Joung Boyoung, Hankey Graeme J, Lip Gregory Y H, Lobban Trudie, Løchen Maja-Lisa, Mairesse Georges, Mbakwem Amam, Noseworthy Peter A, Ntaios George, Steinhubl Steven, Stergiou George, Svendsen Jesper Hastrup, Tieleman Robert G, Wang Jiguang, Poulter Neil R, Healey Jeff S, Freedman Ben
Department of Internal Medicine, University of Turku, Turku, Finland (T.J.N.).
Division of Medicine, Turku University Hospital, Turku, Finland (T.J.N.).
Circulation. 2025 Mar 25;151(12):863-877. doi: 10.1161/CIRCULATIONAHA.124.071047. Epub 2025 Mar 24.
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.
高血压是心房颤动（AF）的主要可改变风险因素，估计超过70%的房颤患者存在高血压。这篇前沿综述由房颤筛查国际协作组织的29位专家成员撰写，旨在总结关于高血压、房颤及其心血管后遗症之间的联系、高血压和房颤的同步筛查以及通过抗高血压治疗预防房颤的现有证据和知识空白。高血压和房颤有着千丝万缕的联系。两者都易于诊断，通常没有症状，且治疗往往不充分。它们共同增加了缺血性中风、心力衰竭和多种痴呆症的风险，导致全因死亡率更高、疾病负担加重以及医疗保健支出增加。具备相关技术的自动上臂袖带血压测量设备可用于同时检测高血压和房颤。然而，使用示波血压监测仪对房颤进行阳性筛查仍需心电图确认。目前的证据表明，年龄≥65岁或患有难治性高血压的高危个体可能从房颤筛查中获益。由于抗高血压治疗能有效降低房颤风险，尤其是在左心室功能不全的个体中，高血压应成为房颤预测和预防的关键靶点，而不仅仅是房颤的一种合并症。尽管如此，未来几年仍有几个重要的知识空白需要填补，包括同时筛查高血压和房颤的理想方法及患者选择，以及预防房颤的最佳抗高血压药物类别和血压目标。
