Such a distortion of atrial anatomy and physiology increases the incidence of AF.S9.8-6 Left atrial pres- sure also increases with ischemic or valvular heart disease and myopathies that are often associated with systemic hyperten- sion, potentially leading to AF. Although management of AF will continue to revolve around restoration of sinus rhythm when appropriate, rate con- trol when it is not, and anticoagulation, control of hypertension is a key component of therapy.S9.8-1,S9.8-2 Treatment of hypertension may prevent new-onsetAF, espe- cially in patients with LVH or LV dysfunction.S9.8-1 Five RCTs have compared the value of antihypertensive agents for reduc- tion of new-onset AF.S9.8-7 S9.8-11 One study suggested superiority of RAS blockade over a CCB,S9.8-8 and another reported supe- riority of RAS blockade over a beta blocker that is no longer recommended for treatment of hypertension.S9.8-9 In the largest trial, there was no difference in incident AF among adults with hypertension assigned to first-step therapy with a diuretic, ACE inhibitor, or CCB.S9.8-10 In ALLHAT, the incidence of AF was 23% higher during first-step antihypertensive therapy with the alpha-receptor blocker doxazosin than with chlorthalidone. Furthermore, the occurrence of AF or atrial flutter during the study, either new onset or recurrent, was associated with an increase in mortality of nearly 2.5-fold.S9.8-10 Recommendation-Specific Supportive Text 1. Although RAS blockade in theory is the treatment of choice for hypertension in patients with prior AF, relative to other classes of agents, all of the trials that have shown clinical superiority of ARBs over other agents were comparisons with CCBs or beta blockers that are no longer recommended as first-line agents for treatment of hypertension.S9.8-2 There are no available trials comparing ACE inhibitors with other drugs or any RAS-blocking agents with diuretics. 9.9. 