24-hour ambulatory blood pressure telemonitoring in patients at risk of atrial fibrillation: results from the TEMPLAR project

Hypertension is the most common risk factor for atrial fibrillation (AF). The ability to screen for potential AF during blood pressure (BP) measurement may be a valuable tool for early AF detection. This study evaluated the frequency of irregular pulse rates suggestive of AF in subjects undergoing ambulatory BP monitoring (ABPM) and compared the characteristics of patients at low risk of presumed AF vs. those at high risk. ABPM recordings were obtained in 4419 subjects aged >= 65 years visiting 304 community pharmacies, with clinically validated automated monitors equipped with an algorithm for detecting possible AF episodes during BP measurement. Subjects with <30% of the readings suggestive of AF were categorized as having a low risk of AF, and those with >= 30% of readings were classified as high risk. A total of 531 subjects (12.0%) were categorized as having a high risk of AF, with the risk increasing with advancing age. Subjects at high risk of AF had lower average systolic BP, higher average diastolic BP and pulse rate (PR), increased BP and PR variabilities, and blunted sleep-associated reductions in BP and PR. In repeated recordings, the reliability of the AF detection algorithm per se was good (kappa 0.476, p = 0.0001; intraclass correlation coefficient 0.56, p = 0.0001). Simultaneous BP measurement and screening for potential AF by ABPM in elderly people in clinical practice may help improve BP control and the detection of subjects at high risk of AF. However, a finding of presumed AF must always be confirmed by an electrocardiogram (ECG).

Automated summary

Hypertension is the most common risk factor for atrial fibrillation (AF) and screening for potential AF during blood pressure measurement can be a valuable tool for early detection. This study evaluated the frequency of irregular pulse rates suggestive of AF in subjects undergoing ambulatory blood pressure monitoring (ABPM), and compared the characteristics of low risk and high risk patients. The results showed that subjects at high risk of AF had specific patterns in their blood pressure and pulse rate measurements. Using ABPM to simultaneously measure blood pressure and screen for potential AF in elderly individuals may help improve blood pressure control and detect high risk subjects. However, a confirmation by electrocardiogram (ECG) is necessary for a diagnosis of AF.