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

Teemu J Niiranen^{1

2

3}, Renate B Schnabel^{4

5}, Aletta E Schutte^{6

7}, Yitschak Biton⁸, Giuseppe Boriani⁹, Claire Buckley¹⁰, Alan C Cameron¹¹, Albertino Damasceno¹², Søren Z Diederichsen¹³, Wolfram Doehner^{14

15

16

17}, Yutao Guo¹⁸, F D Richard Hobbs¹⁹, Boyoung Joung²⁰, Graeme J Hankey^{21

22}, Gregory Y H Lip^{23

24}, Trudie Lobban^{25

26}, Maja-Lisa Løchen^{27

28}, Georges Mairesse²⁹, Amam Mbakwem³⁰, Peter A Noseworthy³¹, George Ntaios³², Steven Steinhubl³³, George Stergiou³⁴, Jesper Hastrup Svendsen^{13

35}, Robert G Tieleman³⁶, Jiguang Wang³⁷, Neil R Poulter³⁸, Jeff S Healey³⁹, Ben Freedman⁴⁰

Affiliations

¹ Department of Internal Medicine, University of Turku, Turku, Finland (T.J.N.).
² Division of Medicine, Turku University Hospital, Turku, Finland (T.J.N.).
³ Department of Public Health and Welfare, Finnish Institute of Health and Welfare, Turku, Finland (T.J.N.).
⁴ Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (R.B.S.).
⁵ German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Germany (R.B.S.).
⁶ School of Population Health, University of New South Wales, Sydney, NSW, Australia (A.E.S.).
⁷ The George Institute for Global Health, Sydney, NSW, Australia (A.E.S.).
⁸ Heart Institute, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (Y.B.).
⁹ Cardiology Division, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy (G.B.).
¹⁰ School of Public Health, University College Cork, Cork Ireland (C.B.).
¹¹ School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK (A.C.C.).
¹² Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.).
¹³ Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark (S.Z.D., J.H.S.).
¹⁴ Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany (W.D.).
¹⁵ German Heart Center of the Charité-Universitätsmedizin Berlin, Berlin, Germany (W.D.).
¹⁶ Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (W.D.).
¹⁷ German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Germany (W.D.).
¹⁸ Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China (Y.G.).
¹⁹ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (F.D.R.H.).
²⁰ Department of Internal Medicine, Yonsei University, Seoul, South Korea (B.J.).
²¹ Perron Institute for Neurological and Translational Science, Perth, WA, Australia (G.J.H.).
²² Centre for Neuromuscular and Neurological Disorders, Medical School, The University of Western Australia, Perth, WA, Australia (G.J.H.).
²³ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK (G.Y.H.L.).
²⁴ Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
²⁵ Arrhythmia Alliance, Stratford Upon Avon, Warwickshire, UK (T.L.).
²⁶ AF Association, Hilton Head Island, SC (T.L.).
²⁷ Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway (M.-L.L.).
²⁸ Department of Cardiology, University Hospital of North Norway, Tromsø, Norway (M.-L.L.).
²⁹ Department of Cardiology, Cliniques du Sud Luxembourg, Arlon, Belgium (G.M.).
³⁰ Department of Medicine, College of Medicine, University of Lagos, idi Araba, Nigeria (A.M.).
³¹ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N.).
³² First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (G.N.).
³³ Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN (S.S.).
³⁴ Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (G.S.).
³⁵ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (J.H.S.).
³⁶ Department of Cardiology, Martini Hospital Groningen, Groningen, the Netherlands (R.G.T.).
³⁷ Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Department of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.).
³⁸ School of Public Health, Imperial College London, London, UK (N.R.P.).
³⁹ Population Health Research Institute, McMaster University, Hamilton, ON, Canada (J.S.H.).
⁴⁰ Heart Research Institute, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, NSW, Australia (B.F.).

PMID: 40127157
DOI: 10.1161/CIRCULATIONAHA.124.071047

Review

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

Teemu J Niiranen et al. Circulation. 2025.

. 2025 Mar 25;151(12):863-877.

doi: 10.1161/CIRCULATIONAHA.124.071047. Epub 2025 Mar 24.

Authors

Affiliations

¹ Department of Internal Medicine, University of Turku, Turku, Finland (T.J.N.).
² Division of Medicine, Turku University Hospital, Turku, Finland (T.J.N.).
³ Department of Public Health and Welfare, Finnish Institute of Health and Welfare, Turku, Finland (T.J.N.).
⁴ Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (R.B.S.).
⁵ German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Germany (R.B.S.).
⁶ School of Population Health, University of New South Wales, Sydney, NSW, Australia (A.E.S.).
⁷ The George Institute for Global Health, Sydney, NSW, Australia (A.E.S.).
⁸ Heart Institute, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (Y.B.).
⁹ Cardiology Division, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy (G.B.).
¹⁰ School of Public Health, University College Cork, Cork Ireland (C.B.).
¹¹ School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK (A.C.C.).
¹² Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.).
¹³ Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark (S.Z.D., J.H.S.).
¹⁴ Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany (W.D.).
¹⁵ German Heart Center of the Charité-Universitätsmedizin Berlin, Berlin, Germany (W.D.).
¹⁶ Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (W.D.).
¹⁷ German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Germany (W.D.).
¹⁸ Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China (Y.G.).
¹⁹ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (F.D.R.H.).
²⁰ Department of Internal Medicine, Yonsei University, Seoul, South Korea (B.J.).
²¹ Perron Institute for Neurological and Translational Science, Perth, WA, Australia (G.J.H.).
²² Centre for Neuromuscular and Neurological Disorders, Medical School, The University of Western Australia, Perth, WA, Australia (G.J.H.).
²³ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK (G.Y.H.L.).
²⁴ Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
²⁵ Arrhythmia Alliance, Stratford Upon Avon, Warwickshire, UK (T.L.).
²⁶ AF Association, Hilton Head Island, SC (T.L.).
²⁷ Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway (M.-L.L.).
²⁸ Department of Cardiology, University Hospital of North Norway, Tromsø, Norway (M.-L.L.).
²⁹ Department of Cardiology, Cliniques du Sud Luxembourg, Arlon, Belgium (G.M.).
³⁰ Department of Medicine, College of Medicine, University of Lagos, idi Araba, Nigeria (A.M.).
³¹ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N.).
³² First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (G.N.).
³³ Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN (S.S.).
³⁴ Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (G.S.).
³⁵ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (J.H.S.).
³⁶ Department of Cardiology, Martini Hospital Groningen, Groningen, the Netherlands (R.G.T.).
³⁷ Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Department of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.).
³⁸ School of Public Health, Imperial College London, London, UK (N.R.P.).
³⁹ Population Health Research Institute, McMaster University, Hamilton, ON, Canada (J.S.H.).
⁴⁰ Heart Research Institute, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, NSW, Australia (B.F.).

PMID: 40127157
DOI: 10.1161/CIRCULATIONAHA.124.071047

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.

Keywords: atrial fibrillation; hypertension; prevention; screening.

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Conflict of interest statement

T.J.N. has received speaking honoraria from Servier Finland, Orion Corporation, and AstraZeneca. G.N. has received advisory board/research support/speaker fees from Abbott, Amgen, Bayer, BMS/Pfizer, Boehringer Ingelheim, Javelin, and Sanofi. R.B.S. has received lecture fees and advisory board fees from BMS/Pfizer and Bayer outside of this work. A.E.S. has received speaker fees from Omron, Medtronic, Aktiia, Servier, Sanofi, and Novartis and is an advisory board member for Skylabs and Abbott. A.C. has received honoraria from BMS, Pfizer, AstraZeneca, and Boehringer Ingelheim. S.Z.D. has received consultancy fees from Bristol-Meyers Squibb/Pfizer, Cortrium, and Vital Beats; speaker fees from Bristol-Meyers Squibb/Pfizer and Bayer; and travel grants from Abbott and Boston Scientific outside of this work. W.D. has received consulting fees and speaker honoraria from Aimediq, Bayer, Boehringer Ingelheim, Boston Scientific, Cardiomatics, Medtronic, and Vifor Pharma and travel support from Pharmacosmos. B.J. has received speaking honoraria from Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo and research funds from Samjin, Yuhan, Medtronic, Boston Scientific, and Abbott Korea. G.J.H. has received honoraria from the American Heart Association (Associate Editor for Circulation), Bristol Myers Squibb (steering committee, AXIOMATIC-SSP trial of milvexian for secondary stroke prevention), and Janssen (Cochair, Executive Committee Librexia Stroke trial of milvexian for secondary stroke prevention). M.L. has received lecture fees from Bayer, Sanofi, and BMS/Pfizer. G.H.M. has received lecture fees from Abbott, Biotronik, Microport, BMS/Pfizer, and Daiichi Sankyo. S.S. has received honoraria from Janssen for executive committee membership in the Heartline trial and is a paid scientific advisor for Prolaio and Tempus. G.S. has received lecture fees from Omron and consulting fees and research grants from Microlife (not related to the present work). J.H.S. is an advisory board member of Vital Beats and Medtronic and has received speaker honoraria from Medtronic. R.T. has received speaking honoraria from Bayer, BMS/Pfizer, and Daiichi-Sankyo. J.S.H. has received research grants and speaking fees from Boston Scientific, Medtronic, Bristol-Meyers Squibb/Pfizer, Servier, and Novartis. B.F. has received honoraria from BMS/Pfizer and Omron.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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MeSH terms

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LinkOut - more resources

Full Text Sources

Medical