Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol
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Objectives This study was designed to evaluate whether different antihypertensive treatment regimens with similar blood pressure reduction have different effects on new-onset atrial fibrillation (AF).Background It is unknown whether angiotensin II receptor blockade is better than beta-blockade in preventing new-onset AF.Methods In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study 9,193 hypertensive patients and patients with electrocardiogram-documented left ventricular hypertrophy were randomized to once-daily losartan- or atenolol-based antihypertensive therapy. Electrocardiograms were Minnesota coded centrally, and 8,851 patients without AF by electrocardiogram or history, who were thus at risk of developing AF, were followed for 4.8 +/- 1.0 years.Results New-onset AF occurred in 150 patients randomized to losartan versus 221 to atenolol (6.8 vs. 10.1 per 1,000 person-years; relative risk 0.67, 95% confidence interval [CI] 0.55 to 0.83, p < 0.001) despite similar blood pressure reduction. Patients receiving losartan tended to stay in sinus rhythm longer (1,809 +/- 225 vs. 1,709 +/- 254 days from baseline, p = 0.057) than those receiving atenolol. Moreover, patients with new-onset AF had two-, three- and fivefold increased rates, respectively, of cardiovascular events, stroke, and hospitalization for heart failure. There were fewer composite end points (n = 31 vs. 51, hazard ratio = 0.60, 95% CI 0.38 to 0.94, p = 0.03) and strokes (n = 19 vs. 38, hazard ratio = 0.49, 95% CI 0.29 to 0.86, p = 0.01) in patients who developed new-onset AF in the losartan compared to the atenolol treatment arm of the study. Furthermore, Cox regression analysis showed that losartan (21% risk reduction) and new-onset AF both independently predicted stroke even when adjusting for traditional risk factors.Conclusions Our novel finding is that new-onset AF and associated stroke were significantly reduced by losartan- compared to atenolol-based antihypertensive treatment with similar blood pressure reduction.
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Secondary analyses of ACE inhibitors or ARBs in patients with heart failure or LVH show a lower incidence of new-onset AF.
“Secondary analyses of ACE inhibitors or ARBs in patients with heart failure or LVH show a lower incidence of new-onset AF.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [246]
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- Authors
- Wachtell, K., Lehto, M., Gerdts, E., Olsen, M. H., Hornestam, B., Dahlöf, B., Ibsen, H., Julius, S., Kjeldsen, S. E., Lindholm, L. H., Nieminen, M. S., & Devereux, R. B.
- Affiliations
- Cornell University (US)
- Helsinki University Hospital (FI)
- Haukeland University Hospital (NO)
- Glostrup Hospital (DK)
- Sahlgrenska University Hospital (SE)
- University of Michigan (US)
- Oslo University Hospital (NO)
- University Hospital of Umeå (SE)
- Corresponding author
- Wachtell, Kristian
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-03
- Volume
- 45
- Issue
- 5
- Pages
- 712-719
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2147918774
- Cited by
- 826
- References
- 27
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 16 · 2023: 17 · 2022: 13 · 2021: 20 · 2020: 20 · 2019: 16 · 2018: 30 · 2017: 32 · 2016: 31 · 2015: 29 · 2014: 36 · 2013: 40 · 2012: 33
- FWCI
- 64.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Rigshospitalet
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- angiotensin II receptor blockade, losartan, atenolol, beta-blockers, stroke prevention, hypertension, left ventricular hypertrophy, antihypertensive therapy, heart failure hospitalization, cardiovascular events, life studies, sinus rhythm maintenance, RAS inhibition, renin-angiotensin system
- MeSH terms
- Adrenergic beta-Antagonists, Aged, Aged, 80 and over, Atenolol, Atrial Fibrillation, Cause of Death, Double-Blind Method, Female, Humans, Hypertension, Male, Middle Aged, Prospective Studies, Risk Factors, Survival Rate, Hypertrophy, Left Ventricular, Losartan, Stroke, Angiotensin II Type 1 Receptor Blockers, Secondary Prevention
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