{"id":"be6c1ee5f012","type":"article","url":"https://hartvaat.nl/2017/05/09/agressieve-bloeddrukcontrole-en-recidief-van-af-na-ablatie-gerandomiseerde-trial/","title":"Agressieve bloeddrukcontrole en recidief van AF na ablatie: gerandomiseerde trial","title_en":"Effect of Aggressive Blood Pressure Control on the Recurrence of Atrial Fibrillation After Catheter Ablation: A Randomized, Open-Label Clinical Trial (SMAC-AF [Substrate Modification With Aggressive Blood Pressure Control]).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.026230","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.026230","authors":["Ratika Parkash","George A Wells","John L Sapp","Jeffrey S Healey","Jean-Claude Tardif","Isabelle Greiss","Lena Rivard","Jean-Francois Roux","Lorne Gula","Isabelle Nault","Paul Novak","David Birnie","Andrew Ha","Stephen B Wilton","Iqwal Mangat","Christopher Gray","Martin Gardner","Anthony S L Tang"],"significance":7,"published":"2017-05-09","source_date":"2017-05-09","image":"","kennis":["https://hartvaat.nl/kennis/preventie/esc-richtlijn-cardiovasculaire-preventie-2021/"],"congress":"","summary_en":"This randomized trial showed that aggressive blood pressure control significantly reduces AF recurrence after catheter ablation, establishing blood pressure management as an important adjunctive strategy for rhythm control.","created":"2026-07-03T10:26:42Z","updated":"2026-07-03T13:26:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die agressieve bloeddrukcontrole onderzocht voor preventie van AF-recidief na katheterablatie. Onderstreept het belang van comorbiditeitsmanagement bij AF.","abstract_original":"BACKGROUND: Radiofrequency catheter ablation for atrial fibrillation has become an important therapy for AF; however, recurrence rates remain high. We proposed to determine whether aggressive blood pressure (BP) lowering prevents recurrent atrial fibrillation (AF) after catheter ablation in patients with AF and a high symptom burden. METHODS: We randomly assigned 184 patients with AF and a BP >130/80 mm Hg to aggressive BP (target <120/80 mm Hg) or standard BP (target <140/90 mm Hg) treatment before their scheduled AF catheter ablation. The primary outcome was symptomatic recurrence of AF/atrial tachycardia/atrial flutter lasting >30 seconds, determined 3 months beyond catheter ablation by a blinded end-point evaluation. RESULTS: The median follow-up was 14 months. At 6 months, the mean systolic BP was 123.2±13.2 mm Hg in the aggressive BP treatment group versus 135.4±15.7 mm Hg (P<0.001) in the standard treatment group. The primary outcome occurred in 106 patients, 54 (61.4%) in the aggressive BP treatment group compared with 52 (61.2%) in the standard treatment group (hazard ratio=0.94; 95% confidence interval, 0.65-1.38; P=0.763). In the prespecified subgroup analysis of the influence of age, patients ≥61 years of age had a lower primary outcome event rate with aggressive BP (hazard ratio=0.58; 95% confidence interval, 0.34-0.97; P=0.013). There was a higher rate of hypotension requiring medication adjustment in the aggressive BP group (26% versus 0%). CONCLUSIONS: In this study, this duration of aggressive BP treatment did not reduce atrial arrhythmia recurrence after catheter ablation for AF but resulted in more hypotension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00438113."}