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Aggressive BP Therapy Won"t Stop AF Recurrences After Ablation: SMAC-AF

Aggressive blood-pressure–lowering therapy in the months prior to scheduled ablation of atrial fibrillation (AF) did not provide sustained protection against AF recurrence 3 months after the procedure, in a randomized, open-label trial presented  at the American Heart Association (AHA) 2016 Scientific Sessions.

The effect on blood pressure was quite dramatic early on in the study. Patients achieved their target blood pressure certainly by 3 months postablation. The mean blood pressure at 6 months was 123 mm Hg across the board, and three-quarters of patients achieved a blood pressure of less than 120 mm Hg.

Randomized, open-label Substrate Modification with Aggressive Blood Pressure Control (SMAC-AF)  trial involved 184 patients with hypertension randomized to either aggressive blood-pressure treatment (n=92) or standard blood-pressure treatment (n=92) up to 6 months prior to scheduled AF ablation. The final analysis involved 88 patients in the aggressive-therapy group who went on to ablation and 85 in the standard-therapy arm who went on to ablation.