Antihypertensive therapy reduces the risk of atrial fibrillation modestly but benefits appear to be larger in patients with heart failure , with no clear evidence of benefit in patients without heart failure .
Previous suggestions of class-specific effects could not be confirmed in this more comprehensive analysis
AIMS High blood pressure is known to be associated with future risk of atrial fibrillation .
Whether such risks can be reduced with antihypertensive therapy is less clear .
We conducted a systematic review and meta- analysis of large-scale r and omized trials that have reported the effect of antihypertensive agents on atrial fibrillation .
Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT).
BACKGROUND  Atrial fibrillation ( AF ) in heart failure ( HF ) is generally considered a negative prognostic factor . Recent studies indicate that the incidence of AF might be decreased by renin angiotensin aldosterone system inhibitors . The identification of a treatment to prevent its occurrence is likely to improve patients outcome . The aims of these subanalyses of Val-HeFT were to assess ( a ) the effects of valsartan in the prevention of AF , ( b ) the independent predictors of this event , and ( c ) the prognostic role of AF occurrence . METHODS AND RESULTS The occurrence of AF was evaluated based on adverse event reports in the patients with HF enrolled in Val-HeFT . Patients were r and omized to valsartan or placebo  on top of their prescribed treatments for HF . During the mean 23 months of follow-up , AF was reported in 287/4395 patients ( 6.53 % ) in sinus rhythm at baseline , of whom 113/2205 ( 5.12 % ) were allocated to valsartan and 174/2190 ( 7.95 % ) to placebo ( P = .0002 ) . Multivariable analysis showed that brain natriuretic peptide ( BNP ) levels at baseline above the median value ( HR 2.28 , 95 % CI 1.75 - 2.98 ) , age over 70 years ( HR 1.51 , 95 % CI 1.17 - 1.95 ) , male sex ( HR 1.53 , 95 % CI 1.07 - 2.18 ) , and the valsartan treatment ( HR 0.63 , 95 % CI 0.49 - 0.81 ) were independently associated with AF occurrence . Cox multivariable regression analysis showed that occurrence of AF was independently associated with a worse prognosis , with the adjusted hazard risks for all-cause mortality and combined mortality/morbidity of 1.40 ( 95 % CI 1.16 - 1.58 ) and 1.38 ( 95 % CI 1.12 - 1.70 ) , respectively . CONCLUSIONS The results of the present study demonstrate that ( a ) adding valsartan to prescribed therapy for HF significantly reduces the incidence of AF by 37 % ; ( b ) BNP level and advanced age were the strongest independent predictors for AF occurrence ; and ( c ) AF occurrence further worsens the outcome in patients with HF
Antihypertensive therapy reduces the risk of atrial fibrillation modestly but benefits appear to be larger in patients with heart failure , with no clear evidence of benefit in patients without heart failure .
Previous suggestions of class-specific effects could not be confirmed in this more comprehensive analysis
AIMS High blood pressure is known to be associated with future risk of atrial fibrillation .
Whether such risks can be reduced with antihypertensive therapy is less clear .
We conducted a systematic review and meta- analysis of large-scale r and omized trials that have reported the effect of antihypertensive agents on atrial fibrillation .