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

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Abstract

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).

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Acknowledgements

The authors wish to thank all the pharmacists for providing patient data for the present study.

Author contributions

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. SO ran the analysis and drafted the manuscript. All authors critically revised and approved the final manuscript.

Funding

This is an investigator-initiated academic study. The study coordinator, the Italian Institute of Telemedicine (a not-for-profit organization), is the promoter and main sponsor of the study and made available its resources and facilities for conducting the trial. The work was also in part supported by the Karolinska Institutet Research Foundations (Stockholm, Sweden), which provided funding to TK, and the Swedish Society of Medicine, which provided funding to KL.

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Authors and Affiliations

  1. Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy

    Stefano Omboni, Tommaso Ballatore, Franco Rizzi, Fernanda Tomassini, Luca Campolo & Edoardo Panzeri

  2. Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation

    Stefano Omboni

  3. Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden

    Kristina Lundwall & Thomas Kahan

  4. Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden

    Kristina Lundwall & Thomas Kahan

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  1. Stefano Omboni
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  2. Tommaso Ballatore
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  3. Franco Rizzi
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  4. Fernanda Tomassini
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  5. Luca Campolo
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  6. Edoardo Panzeri
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  7. Kristina Lundwall
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  8. Thomas Kahan
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Correspondence to Stefano Omboni.

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Conflict of interest

SO is a scientific consultant of Biotechmed Ltd, provider of telemedicine services. All other authors declare no conflicts of interest regarding the publication of this paper.

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Omboni, S., Ballatore, T., Rizzi, F. et al. 24-hour ambulatory blood pressure telemonitoring in patients at risk of atrial fibrillation: results from the TEMPLAR project. Hypertens Res 45, 1486–1495 (2022). https://doi.org/10.1038/s41440-022-00932-1

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