Google manson enzo ra = 208 ray eS ae 6 — ost ACE an Google snemadenttstdaneanshastaen = Boo fa 2) =aACE inhibitors and angictensin recopler blockers (and bela blockers and ‘mineralacoticoid receptor anlagonisisif heart failure coexsis) should be ‘considered as antnypertensive agents in patients atriskof new ‘oF roourrent atrial fbvillaton, Fig.9.6 ‘The 2013 ESH/ESC Hypertension Guidelines 49] state Mla indication for inhibitors of the renin-angiotensin-aklosterone system (ACE-inhibitors, ARBs, aldosterone antagonists. and. beta-blockers) in people with high nsk of developing tril fibrillation However, most of the trials included in these meta-analyses were not designed to investigate AF. A pre-specified analysis of the VALUE trial was conducted to compare the effects of the ARB valsartan with the calcium channel blocker amlo- on new-onset AF in >13,000 patients with hypertension at high cardiovascu- lar risk [32]. Over the course of follow-up, the use of valsartan (vs. amlodipine) was associated with a 16% reduction (p< 0.0455) in the incidence of at least 1 docu- mented occurrence of new-onset AF and reduced the incidence of persistent AF by 32% (p<0.0046). Similar findings showing the benefit of ARBs in reducing the \cidence of new-onset AF were also documented in pre-specified analysis of data from the LIFE study, in which the incidence of new-onset AF was compared between patients treated with losartan vs, the beta-blocker, atenolol [9]. In the ALLHAT study 42.418 participants were randomized to 4 antihypertensive