Older adults with high blood pressure who undergo ablation for atrial fibrillation may face fewer recurring irregular heart rhythms if treated with a two-drug blood pressure combination rather than a single medication, according to preliminary research presented at the American Heart Association's Scientific Sessions 2026 in Chicago.
The randomized, controlled trial enrolled 320 patients with both AFib and hypertension who received catheter ablation at three hospitals in China between February 2023 and January 2025. Participants averaged 68 years old, 41.2% were women and 66.6% had paroxysmal AFib. After ablation, 161 patients were assigned to sacubitril/valsartan at 100 mg once daily and 159 to valsartan at 80 mg once daily.
At 12 months, documented atrial tachyarrhythmia recurrence occurred in 18% of the sacubitril/valsartan group compared with 28.3% of the valsartan-alone group. Systolic blood pressure fell by about 10 mm Hg in both groups, and researchers found no significant difference in 24-hour ambulatory blood pressure reduction between the treatments.
"Our findings reinforce the idea that treating AFib does not end with the ablation procedure, and managing hypertension remains an important part of comprehensive AFib care," said lead author Wei Zhang, M.D., Ph.D., a cardiologist at the Shanghai Institute of Hypertension at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. "What was particularly interesting to us was that the difference in AFib recurrence was observed even though blood pressure reductions were similar between the two groups."
The result suggests the choice of blood pressure medication, not just the magnitude of blood pressure lowering, may influence whether AFib returns after an initially successful ablation. High blood pressure can stress the heart over time, contributing to enlargement, increased pressure and scarring of heart muscle, creating conditions in which AFib can develop again.
The study has notable limitations. It was open-label, meaning patients and physicians knew which medication was assigned, though ECG-documented recurrence events were centrally adjudicated by an independent team blinded to treatment. Rhythm monitoring was intermittent rather than continuous, so brief or symptom-free episodes may have been missed. The findings also focus on older adults with hypertension in China and may not apply to younger adults, people without hypertension or patients elsewhere.
The American Heart Association notes that abstracts presented at its scientific meetings are not peer-reviewed and are considered preliminary until published as a full manuscript in a peer-reviewed journal. The full abstract is available in the meeting's Online Program Planner, and additional material appears on the release link.
For patients and clinicians, the trial points to hypertension management as a continuing priority after ablation. Zhang cautioned that the results should not be read as suggesting ablation alone or medication alone is sufficient. "AFib 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 said. Guidance on Diagnosis and Treatment of Atrial Fibrillation remains available through the Association, which also publishes resources at heart.org and stroke.org.
