Among older adults with high blood pressure and atrial fibrillation (AF), treatment with a combination of two blood pressure medications was associated with fewer recurring irregular heart rhythms after an ablation procedure compared to one of the medications alone, as per new, independent, preliminary, late-breaking science presented at the 2026 American Heart Association (AHA) Scientific Sessions (7–9 November, Chicago, USA).
Although catheter ablation can be used to treat the abnormal electrical activity responsible for AF, it may not reverse underlying structural changes in the heart that could also contribute to the condition—and, over time, high blood pressure can place additional stress on the heart and contribute to enlargement, increased pressure and scarring of the heart muscle, as well as narrowing of the arteries. These physical changes to the heart create an environment in which AF can develop again even after an initially successful ablation.
“For many patients, AF recurrence after an ablation can mean the return of symptoms, additional monitoring, medications or treatments to help restore a normal heart rhythm, and, sometimes, another ablation procedure,” said Wei Zhang (Shanghai Jiao Tong University School of Medicine, Shanghai, China), the study’s lead author. “Our goal was to find out whether treatment with a single or combination of blood pressure medications after ablation could affect the chance of AF returning.”
The study in question was a randomised controlled trial including 320 patients aged 55 years and older with both AF and hypertension—in-clinic blood pressure >130/80mmHg—who received catheter ablation at three hospitals in China between February 2023 and January 2025. Participants had an average age of 68 years, 41.2% were women, and 66.6% had paroxysmal AF. After the ablation procedure, 161 patients were randomly assigned to start treatment with a combination of two medications, sacubitril and valsartan (100mg once daily), while 159 patients were randomly assigned to start valsartan only (80mg once daily).
In the trial, at 12 months after an ablation procedure, treatment with sacubitril and valsartan was associated with a lower rate of documented recurrence of AF or related atrial arrhythmias, as compared with patients who received valsartan alone. Documented recurrence of atrial tachyarrhythmias was observed in 18% of participants in the sacubitril-valsartan group compared to 28.3% in the valsartan group.
Additionally, systolic blood pressure measured at clinic visits fell by roughly 10mmHg in both groups, and there was no significant difference regarding the reduction in 24-hour ambulatory blood pressure between the two treatment groups.
“Our findings reinforce the idea that treating AF does not end with the ablation procedure, and managing hypertension remains an important part of comprehensive AF care,” Zhang commented. “What was particularly interesting to us was that the difference in AF recurrence was observed even though blood pressure reductions were similar between the two groups. This raises the possibility that, after AF ablation, the type of treatment used to lower blood pressure may be as important as how much blood pressure is lowered.”
Zhang also stated that the study findings should not be interpreted as suggesting that ablation alone or medication alone is sufficient to prevent AF from recurring.
“AF is a complex condition, and successful long-term management requires both effective rhythm treatment and careful management of underlying cardiovascular risk factors—particularly hypertension,” he added.
The researchers also note that there were several limitations to their study. Firstly, it was an open-label trial, meaning that patients and treating physicians knew which medication group they had been assigned to; however, electrocardiogram (ECG)-documented recurrence events were centrally adjudicated by an independent team blinded to information about which patients received which treatment. Heart rhythm monitoring was intermittent rather than continuous, meaning some brief or symptom-free AF episodes may have been missed. The study also focused on older adults with hypertension undergoing AF ablation in China, so the findings may not necessarily apply to younger adults, people without hypertension, or people living in other countries, the investigators say.
