Opportunistic screening for atrial fibrillation and elevated/hypertensive blood pressure: clinical factors associated with abnormal findings

Abstract Background Hypertension and atrial fibrillation (AF) are common risk factors for cardiovascular diseases and opportunistic screening for detecting AF and elevated blood pressure (BP) is increasingly promoted. Aim To assess the prevalence of AF, elevated BP values and values suggestive of hypertension within a programme of opportunistic screening among adults performed during meetings or social recreational activities. Methods We performed an opportunistic screening in adults ( 18 years old), using a handheld single-lead ECG device (1-minute recordings) and an automated oscillometric BP measuring device. At enrollment, patients released an informed consent. Positive screening for AF with handheld device was confirmed with 12-lead ECG. BP cut-offs were defined according to the 2024 ESC Guidelines (normal BP as ≤120/70mmHg, elevated BP as 121-139/71-89 mmHg; hypertension as ≥140/90mmHg). Results 1,657 patients were included (mean age: 58.9 ±16.0 years, 55.8% females), and 13 (0.8%) had a positive screening test for AF confirmed by 12-lead ECG. Newly detected elevated/hypertensive BP values were found in 58.2% of participants, while among patients with a prior diagnosis of hypertension, uncontrolled BP was found in 29.0% of cases. Overall, 212 subjects (12.8%) had normal BP (mean age: 50.7 ± 17.3 years, 66.5% females), 1,149 (69.3%) had elevated BP values (mean age: 59.4 ± 15.9 years, 56.1% females), while 296 (17.9%) had hypertensive BP values (mean age: 62.7 ± 13.1 years, 47.3% females). History of hypertension was reported in 12.7%, 29.6%, and 47.3% of these subgroups, respectively. At multivariable logistic regression analysis, age ≥65 and prior ischemic stroke were associated with positive AF screening (OR: 5.70; 95%CI: 1.36-39.25 and 10.70; 95%CI: 1.45-50.73, respectively). Older age (both 65-75 and 75 years old), male sex (OR:1.71; 95%CI:1.25-2.34) and history of hypertension (OR: 2.70 95%CI: 1.74-4.31) were associated with odds of elevated/hypertensive BP values at the time of screening (Figure 1). When modelled as a continuous variable, the association of age with odds to be found with high values of BP at screening appeared to be linear (p for non-linearity= 0.317). Conclusions In a large cohort of asymptomatic subjects undergoing opportunistic screening for AF and abnormal BP values, prevalence of new AF diagnosis was 0.8% and was associated with age ≥65 and prior ischemic stroke. Elevated/hypertensive BP values in non-hypertensive subjects were found in more than half of screened subjects and among hypertensive patients, uncontrolled BP values were found in almost 1 out of 3 patients.