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Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol
Open accessAbstract
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.”
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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Metadata
- 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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