Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. It is associated with the risk of developing some adverse cardiovascular events, including cerebral embolism and heart failure [1]. The development of AF depends on a variety of risk factors, including age, sex, race, hypertension, heart failure, coronary artery disease, valvular heart disease, obesity, diabetes, and chronic kidney disease [2]. Among these risk factors, hypertension has been established to be the most important factor [3, 4] In addition, in patients with AF, hypertension is one of the risk factors for the development of cerebral embolism [5]. In this regard, the Japanese guideline on pharmacotherapy of cardiac arrhythmias recommends the use of the CHADS2 score for the risk assessment of thromboembolism in patients with AF, in which "H" indicates hypertension [6]. An early diagnosis and the subsequent initiation of appropriate treatment for AF, including anticoagulation therapy, is strongly required in hypertensive patients. However, the diagnosis of AF is not easy in the clinical setting. Almost 40% of AF patients are asymptomatic [7]. Most of these patients are diagnosed as having AF at annual health check-up examinations [7]. The type of AF that is diagnosed at health check-up examinations is mostly the persistent type. Paroxysmal and asymptomatic AF is difficult to diagnose because there are few chances to detect AF by standard 12-lead electrocardiogram (ECG) [8]. Some of these patients unfortunately develop cerebral embolism before the diagnosis of AF. Although detailed assessment with 24-h Holter ECG is needed to detect AF, the chance of detection is limited [9]. On the other hand, ambulatory blood pressure monitoring (ABPM) is currently considered the most accurate method for diagnosing hypertension [10, 11]. Several institutions have recommended that most or all subjects with suspected hypertension undergo ABPM [12]. Notably, an ABPM device that especially implements an algorithm to automatically detect AF during each blood pressure measurement has been developed in recent years. In fact, Kollias et al. [13] demonstrated the high diagnostic accuracy of detecting AF using 24-h ABPM devices with AF detection algorithms.
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