Antihypertensive treatment and risk of atrial fibrillation: a nationwide study
Abstract
AIMS: To examine the associations between antihypertensive treatment with angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs), β-blockers, diuretics, or calcium-antagonists, and risk of atrial fibrillation. We examined these associations using the entire Danish population from 1995 through 2010. METHODS AND RESULTS: Excluding medication used in atrial fibrillation, we matched individuals on ACEi monotherapy 1:1 with individuals on β-blocker (n = 48 658), diuretic (n = 69 630), calcium-antagonist (n = 57 646), and ARB monotherapy (n = 20 158). Likewise, individuals on ARB monotherapy were matched 1:1 with individuals on β-blocker (n = 20 566), diuretic (n = 20 832), calcium-antagonist (n = 20 232), and ACEi monotherapy (n = 20 158). All were free of atrial fibrillation and of predisposing diseases like heart failure, ischaemic heart disease, diabetes mellitus, and hyperthyroidism at baseline and none received any other antihypertensive medication. We studied risk of atrial fibrillation, and used risk of stroke, influenced by lowering blood pressure rather than renin-angiotensin system blockade per se, as an indicator of the importance of blood pressure lowering per se. Hazard ratios of atrial fibrillation for ACEi and ARB monotherapy were 0.12 (95% CI: 0.10-0.15) and 0.10 (0.07-0.14) compared with β-blocker, 0.51 (0.44-0.59) and 0.43 (0.32-0.58) compared with diuretic, and 0.97 (0.81-1.16) and 0.78 (0.56-1.08) compared with calcium-antagonist monotherapy. Risk of stroke did not differ among the five antihypertensive medications. CONCLUSION: Use of ACEis and ARBs compared with β-blockers and diuretics associates with a reduced risk of atrial fibrillation, but not stroke, within the limitations of a retrospective study reporting associations. This suggests that controlling activation of the renin-angiotensin system in addition to controlling blood pressure is associated with a reduced risk of atrial fibrillation.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A recent analysis of the Danish healthcare database suggests a beneficial effect of ACE inhibitors or ARBs on the occurrence of overt AF.
“A recent analysis of the Danish healthcare database with long-term monitoring of the effect of different antihypertensive agents on the occurrence of overt AF suggests a beneficial effect of ACE inhibitors or ARBs.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [245]
Initial treatment of uncomplicated hypertension with ACE inhibitors or ARBs reduces incident atrial fibrillation compared with other hypertensive agents.
“A Danish cohort study also suggested that initial treatment of uncomplicated hypertension with ACE inhibitors or ARBs reduces incident AF compared with other hypertensive agents.245”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [245]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Kannel, W. B., Wolf, P. A., Benjamin, E. J., & Levy, D. (1998) · The American Journal of Cardiology · doi:10.1016/s0002-9149(98)00583-9 · Cited by 2,033 · see citing works
Hansson, L., Lindholm, L. H., NISKANEN, L. K., Lanke, J., Hedner, T., Niklason, A., LUOMANMÄKI, K., Dahlöf, B., Fairé, U. D., Mörlin, C., et al. (1999) · The Lancet · doi:10.1016/s0140-6736(98)05012-0 · Cited by 1,991 · see citing works
Experience from a multicentre stroke register: a preliminary report.
Hatano, S. (1976) · PubMed · Cited by 1,522 · see citing works
Hansson, L., Lindholm, L. H., Ekbom, T., Dahlöf, B., Lanke, J., Scherstén, B., Wester, P.-O., Hedner, T., & Fairé, U. D. (1999) · The Lancet · doi:10.1016/s0140-6736(99)10327-1 · Cited by 1,442 · see citing works
Statin use and reduced cancer-related mortality
Nielsen, S. F., Nordestgaard, B. G., & Bojesen, S. E. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1201735 · Cited by 1,030 · see citing works
Self-citationFuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Kay, G. N., Huezey, J.-Y. L., Lowe, J. E., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.09.013 · Cited by 921 · see citing works
Wachtell, K., Lehto, M., Gerdts, E., Olsen, M. H., Hornestam, B., Dahlöf, B., Ibsen, H., Julius, S., Kjeldsen, S. E., Lindholm, L. H., et al. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.10.068 · Cited by 826 · see citing works
Statin Use and Reduced Cancer-Related Mortality
Klop, C., Driessen, J. H. M., & de Vries, F. (2013) · New England Journal of Medicine · doi:10.1056/nejmc1214827 · Cited by 722 · see citing works
Vermès, E., Tardif, J., Bourassa, M. G., Racine, N., Lévesque, S., White, M., Guerra, P. G., & Ducharme, A. (2003) · Circulation · doi:10.1161/01.cir.0000072793.81076.d4 · Cited by 577 · see citing works
Kumagai, K., Nakashima, H., Urata, H., Gondo, N., Arakawa, K., & Saku, K. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00464-9 · Cited by 472 · see citing works
Maggioni, A. P., Latini, R., Carson, P. E., Singh, S. N., Barlera, S., Glazer, R. D., Masson, S., Cerè, E., Tognoni, G., & Cohn, J. N. (2005) · American Heart Journal · doi:10.1016/j.ahj.2004.09.033 · Cited by 406 · see citing works
Ducharme, A., Swedberg, K., Pfeffer, M. A., Cohen-Solal, A., Granger, C. B., Maggioni, A. P., Michelson, E. L., McMurray, J. J. V., Olsson, L., Rouleau, J. L., et al. (2006) · American Heart Journal · doi:10.1016/j.ahj.2005.06.036 · Cited by 352 · see citing works
Ehrlich, J. R., Hohnloser, S. H., & Nattel, S. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi668 · Cited by 298 · see citing works
Schmieder, R. E., Kjeldsen, S. E., Julius, S., McInnes, G. T., Zanchetti, A., & Hua, T. A. (2008) · Journal of Hypertension · doi:10.1097/hjh.0b013e3282f35c67 · Cited by 231 · see citing works
Manolis, A. J., Rosei, E. A., Coca, A., Cifkova, R., Erdine, S. E., Kjeldsen, S., Lip, G. Y. H., Narkiewicz, K., Parati, G., Redon, J., et al. (2012) · Journal of Hypertension · doi:10.1097/hjh.0b013e32834f03bf · Cited by 198 · see citing works
Angiotensin II-antagonist in paroxysmal atrial fibrillation (ANTIPAF) trial
Goette, A., Schön, N., Kirchhof, P., Breithardt, G., Fetsch, T., Häusler, K. G., Klein, H. U., Steinbeck, G., Wegscheider, K., & Meinertz, T. (2012) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.111.965178 · Cited by 187 · see citing works
Baseline characteristics of patients with atrial fibrillation: The AFFIRM Study
The AFFIRM Investigators (2002) · American Heart Journal · doi:10.1067/mhj.2002.122875 · Cited by 172 · see citing works
Boldt, A., Wetzel, U., Weigl, J., Garbade, J., Lauschke, J., Hindricks, G., Kottkamp, H., Gummert, J. F., & Dhein, S. (2003) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.07.014 · Cited by 127 · see citing works
Ørsted, D. D., Bojesen, S. E., Nielsen, S. F., et al. (2011) · European Urology · doi:10.1016/j.eururo.2011.06.016 · Cited by 122 · see citing works
Self-citationVenous Thromboembolism and Risk of Idiopathic Interstitial Pneumonia: A Nationwide Study
Sode, B. F., Dahl, M., Nielsen, S. F., & Nordestgaard, B. G. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200912-1951oc · Cited by 114 · see citing works
Self-citationGoette, A., & Lendeckel, U. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.03.026 · Cited by 111 · see citing works
Risk for Incident Atrial Fibrillation in Patients Who Receive Antihypertensive Drugs
Schaer, B. A., Schneider, C., Jick, S. S., Conen, D., Osswald, S., & Meier, C. R. (2010) · Annals of Internal Medicine · doi:10.7326/0003-4819-152-2-201001190-00005 · Cited by 106 · see citing works
Hypertension and atrial fibrillation: epidemiology, pathophysiology and therapeutic implications
Lau, Y.-F., Yiu, K., Siu, C.-W., & Tse, H.-F. (2011) · Journal of Human Hypertension · doi:10.1038/jhh.2011.105 · Cited by 100 · see citing works
Salehian, O., Healey, J. S., Stambler, B. S., Alnemer, K., Almerri, K., Grover, J., Bata, I. R., Mann, J. F. E., Matthew, J., Pogue, J. M., et al. (2007) · American Heart Journal · doi:10.1016/j.ahj.2007.04.062 · Cited by 92 · see citing works
Impact of Hypertension on Stroke
Dubow, J. S., & Fink, M. E. (2011) · Current Atherosclerosis Reports · doi:10.1007/s11883-011-0187-y · Cited by 78 · see citing works
Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM
Murray, K. T., Rottman, J. N., Arbogast, P. G., Shemanski, L. R., Primm, R. K., Campbell, W. B., Solomon, A. J., Olgin, J. E., Wilson, M., Dimarco, J., et al. (2004) · Heart Rhythm · doi:10.1016/j.hrthm.2004.08.008 · Cited by 74 · see citing works
Associations between first and second primary cancers: a population-based study
Nielsen, S. F., Nordestgaard, B. G., & Bojesen, S. E. (2011) · Canadian Medical Association Journal · doi:10.1503/cmaj.110167 · Cited by 54 · see citing works
Self-citationPalardy, M., Ducharme, A., Nattel, S., Tardif, J., White, M., Racine, N., Tétreault, K., Dabouz, F., Talajic, M. R., & Roy, D. (2008) · Canadian Journal of Cardiology · doi:10.1016/s0828-282x(08)70670-6 · Cited by 21 · see citing works
Risk stratification of patients with atrial fibrillation: Biomarkers and other future perspectives
Providencia, R. A. (2012) · World Journal of Cardiology · doi:10.4330/wjc.v4.i6.195 · Cited by 10 · see citing works
Nielsen, S. F., Bojesen, S. E., Birgens, H., & Nordestgaard, B. G. (2011) · Blood · doi:10.1182/blood-2011-02-337170 · Cited by 8 · see citing works
Self-citationMarott, S. C. W., Nordestgaard, B. G., Jensen, G. B., Tybjærg‐Hansen, A., & Benn, M. (2012) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.12050 · Cited by 6 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 2
- Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and pre- disposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:2N -9N.
- Nielsen SF, Nordestgaard BG, Bojesen SE. Type of second primary cancer by type of first cancer: a Danish nationwide study. Can Med Ass J 2012;184:E57-E69.
Cited by
Sorted by citations
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
- Authors
- Marott, S. C. W., Nielsen, S. F., Benn, M., & Nordestgaard, B. G.
- Affiliations
- University of Copenhagen (DK)
- Corresponding author
- Nordestgaard, Børge G.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-12-17
- Volume
- 35
- Issue
- 18
- Pages
- 1205-1214
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W1984022271
- Cited by
- 107
- References
- 32
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 4 · 2022: 6 · 2021: 10 · 2020: 7 · 2019: 12 · 2018: 10 · 2017: 13 · 2016: 19 · 2015: 9 · 2014: 4
- FWCI
- 7.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Sundhed og Sygdom, Det Frie Forskningsråd
- Gentofte Hospital
- Herlev Hospital
- Forsknings- og Innovationsstyrelsen
- Medical Research Council
- Danish Agency for Science and Higher Education
- 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
- atrial fibrillation, antihypertensive drugs, ACE inhibitors, angiotensin receptor blockers, beta-blockers, diuretics, calcium channel blockers, blood pressure reduction, stroke risk, renin-angiotensin system blockade, hypertension, matched cohort comparison
- MeSH terms
- Adrenergic beta-Antagonists, Aged, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Atrial Fibrillation, Calcium Channel Blockers, Denmark, Diuretics, Female, Humans, Hypertension, Male, Middle Aged, Retrospective Studies, Risk Factors, Incidence, Stroke, Angiotensin Receptor Antagonists
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
