Based on recent research such as the RACE 3 trial, the European Heart Association atrial fibrillation (AF) guidelines include correction of unhealthy lifestyle habits and strict blood pressure control (less than 120/80mmHg) to improve the  AF burden and symptoms. Targeted treatment is recommended. The 2018 European Society of Cardiology/Hypertension found that when diuretics are used to treat hypertension, thiazide-like diuretics such as chlorthalidone have a greater effect on lowering blood pressure longer action time than hydrochlorothiazide. There are also reports that one-time chlorthalidone diuretics are expected to play a role as a blood pressure drug to prevent heart failure. In this respect, in addition to medication for atrial fibrillation, management of blood pressure for hypertension is expected to not only improve the quality of life for patients with AF but also significantly affect the prognosis. There is still little research on the effect of active combination therapy on blood pressure control in patients with atrial fibrillation, the recurrence of atrial fibrillation, quality of life, and further prognosis. This study is a combination therapy for atrial fibrillation patients with hypertension. How much the active treatment of the back affects blood pressure control, and the clinical effect of it is compared and analyzed. Through this, it is expected that it will not only present the actual basis for the existing guidelines for atrial fibrillation in Korea but also as a guideline for the management of patients with atrial fibrillation with high blood pressure in actual clinical practice.

Treatment

-Intensive BP treatment:




Antihypertensive drug (renin-angiotensin system blocker + calcium channel antagonist + long-acting time diuretic (chlorthalidone) combined therapy with the single-pill (SPC)) therapy was used to measure target blood pressure during the follow-up period, on average 120 / Group adjusted to less than 90mmHg




-General blood pressure control group (standard BP treatment):




Renin-angiotensin system blockers (Angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB)), calcium channel antagonists, and other general antihypertensive drugs were used to control the target blood pressure to an average of less than 140/90mmHg during the follow-up period. group

Arm Label

Target Number of Participant

Arm Type

Arm Description

Antihypertensive drug (renin-angiotensin system blocker + calcium channel antagonist + long-acting time diuretic (chlorothalidone) combined therapy with single pill (SPC)) therapy was used to measure target blood pressure during follow-up period, on average 120 / Group adjusted to less than 90mmHg.
According to each blood pressure target, antihypertensive drugs and atrial fibrillation treatment were performed, clinical follow-up was performed at 3, 6, and 9 months, and active blood pressure monitoring was performed at 12 months.
In both the active blood pressure control group and the general blood pressure treatment group, the treatment of patients is performed according to standard treatment procedures in the treatment underlying hypertension and atrial fibrillation.

Arm Label

Target Number of Participant

Arm Type

Arm Description

Renin-angiotensin system blocker (Angiotensin converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB)), calcium channel antagonist, etc. group.
According to each blood pressure target, antihypertensive drugs and atrial fibrillation treatment were performed, clinical follow-up was performed at 3, 6, and 9 months, and active blood pressure monitoring was performed at 12 months.
In both the active blood pressure control group and the general blood pressure treatment group, the treatment of patients is performed according to standard treatment procedures in the treatment underlying hypertension and atrial fibrillation.

Gender

Age

Description

① Patients aged 19 or older with non-membrane atrial fibrillation
② Patients with hypertension who need medication
*Patients with hypertension who require drug treatment currently follow the guidelines for hypertension treatment of the Korean Society of Hypertension in 2018.
③ Patients who have not previously taken antihypertensive drugs
④ Patients who agree with the purpose of this study

① Atrial fibrillation accompanied by severe heart malformation or structural heart disease affected by hemodynamics
② Severe renal dysfunction
③ Patients with a history of atrial fibrillation high frequency electrode catheter resection or labyrinth surgery
④ Patients with significant mitral valve stenosis (moderate or higher)
⑤ Patients with active internal bleeding
⑥ Patients diagnosed with hypertrophic cardiomyopathy
⑦ Polycystic kidney disease
⑧ Significant comorbid disease
⑨ Patients whose survival period is expected to be less than 1 year
⑩ Patients with drug or alcohol addiction
⑪ Patients diagnosed with stroke within the last 3 months
⑫ Patients judged unsuitable for participation in clinical trials by the judgment of other researchers

After the normal sinus rhythm, the patient included in the RCT was analyzed using the retention rate and intention to treat analysis.Including interim analysis of patients who followed up for more than 30 days using per-protocol analysis.

3, 6, 9 months

-Blood pressure control (average of self-monitoring blood pressure, average of 24-hour active blood pressure monitoring)-Assessment of the incidence of cerebral infarction, hospitalization, cardiovascular events, mortality, and quality of life (SF-36)

Conduct 3, 6, 9 months and monitor active blood pressure at 12 months