Does Aggressive Blood Pressure Treatment Reduce Afib Recurrence?

MARCH 10, 2017

Atrial fibrillation (AF) recurrence does not appear to be affected by aggressive blood pressure lowering treatments. A study published in Circulation finds that patients undergoing catheter ablation did not experience any beneficial effects.
 
Although catheter ablation is a common treatment for AF, recurrence rates remain high. The study’s researchers aimed to determine whether an aggressive approach to reducing blood pressure helped prevent recurrent AF after catheter ablation.
 
All the evaluated individuals were patients at 13 tertiary care centers in Canada.
 
Patients who exhibited several AF symptoms, including refraction or intolerance of at least 1 class I or class III antiarrhythmic agent, were given standard blood pressure treatment with a target of <140/90 mm Hg or aggressive treatment with a target of <120/80 mm Hg. The patients’ baseline blood pressure was >130/80 mm Hg, and they underwent their designated treatment for 3.5 months and were followed for a period of 14 months afterward.
 
Some of the key findings included:
  • The mean systolic BP at the 6-month mark was 123.2±13.2/76.7±11.4 mm Hg in the aggressive treatment group vs 135.4±15.7/80.8±10.2 mm Hg in the standard care group (P <.001).
  • The primary outcome (symptomatic recurrence of AF/atrial tachycardia/atrial flutter lasting >30 seconds) occurred in 61.4% of patients in the aggressive treatment group vs 61.2% in the standard group (hazard ratio [HR], 0.94; 95% CI, 0.65-1.38, P =.763)
  • Hypotension requiring medication adjustment was more frequent with aggressive vs standard treatment (26% vs 0%).
However, older adults had lower rates of AF recurrence when treated with the aggressive approach. Overall, the researchers concluded that in most patients, aggressive blood pressure management did not reduce AF recurrence after catheter ablation, but did result in more hypotension.
 
Reference
 
Parkash R, Wells GA, Sapp JL, et al. The effect of aggressive blood pressure control on the recurrence of atrial fibrillation after catheter ablation: a randomized, open label, clinical trial (substrate modification with aggressive blood pressure control: SMAC-AF). Circulation. 2017; doi:10.1161/CIRCULATIONAHA.116.026230.
 

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