The antihypertensive treatment in hypertension combined with arrhythmias should treat both the symptoms and the root cause, not only to control blood pressure at the desired level, but also to minimize or reverse its damage to the heart (e.g., left ventricular remodeling), and to maintain a normal neuroendocrine system as well as water-electrolyte balance. Treatment principles The main goal of treatment is to control blood pressure, minimize or reverse its damage to the heart, and reduce the risk of long-term cardiovascular morbidity and mortality. If arrhythmias are frequent and symptoms are so pronounced that they interfere with daily work and life, they can be controlled with antiarrhythmic drugs, without significant differences from the management of arrhythmias of other etiologies. The benefits of antihypertensive therapy come mainly from the lowering of blood pressure itself, so the primary goal of treatment for patients with hypertension is to achieve the blood pressure target. Patients with general hypertension should have their blood pressure strictly controlled to <140/90 mmHg, with further reductions if tolerated. High/very high risk patients with co-morbid diabetes, stroke, myocardial infarction, renal insufficiency, and proteinuria should have their blood pressure lowered to <130/80 mmHg. Treatment should be administered before significant cardiovascular compromise occurs, when lowering the blood pressure is more likely to bring it into compliance. In the elderly, in patients with comorbid diabetes mellitus, and in patients with cardiovascular compromise, controlling systolic blood pressure to 140 mmHg or even <130 mmHg is often difficult, so intensive antihypertensive therapy in these patients is important, and a combination antihypertensive regimen should be used as early as possible. When hypertension is combined with arrhythmias, cardiovascular damage is usually already present. The goal of treatment is not only to lower blood pressure to the desired level, but also to protect target organs, such as reversing left ventricular remodeling and protecting the kidneys. In order to achieve the target blood pressure level, most patients need to combine two or more types of drugs. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor antagonists (ARBs) are effective in controlling excessive nocturnal blood pressure levels, restoring the circadian rhythm of blood pressure, improving large artery compliance, and protecting ischemic myocardium. In particular, ACEI is beneficial in hypertensive patients with combined left ventricular hypertrophic arrhythmias, and it also reduces the incidence of atrial fibrillation in hypertensive patients. Calcium channel blockers can lower blood pressure while reversing left ventricular hypertrophy, improving left ventricular diastolic compliance and myocardial ischemia, so calcium antagonists should be preferred in hypertension combined with left ventricular hypertrophy and arrhythmias, and the effect is better when combined with ACEI. The incidence of cardiac arrhythmias in patients with hypertension can be reduced to some extent. In conclusion, the antihypertensive treatment of hypertension combined with arrhythmias should treat both the symptoms and the root cause, not only to control the blood pressure at the ideal level, but also to minimize or reverse the damage to the heart (e.g., left ventricular remodeling), and to maintain a normal neuroendocrine system and water-electrolyte balance.