Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol

• DOI: 10.1016/j.jacc.2004.10.068
• Publication Date: 2005-02-24T13:00:57Z
• Authors: Kristian Wachtell; Mika Lehto; Eva Gerdts; Michael H. Olsen; Björn Hornestam; Björn Dahlöf; Hans Ibsen; Stevo Julius; Sverre E. Kjeldsen; Lars H. Lindholm; Markku S. Nieminen; Richard B. Devereux
• Keywords: Male; Adrenergic beta-Antagonists; Losartan; 03 medical and health sciences; 0302 clinical medicine; Double-Blind Method; Risk Factors; Cause of Death; Atrial Fibrillation; Secondary Prevention; Humans; Prospective Studies; Aged; Aged, 80 and over; Middle Aged; 3. Good health; Stroke; Survival Rate; Atenolol; Hypertension; Female; Hypertrophy, Left Ventricular; Cardiology and Cardiovascular Medicine; Angiotensin II Type 1 Receptor Blockers

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).It is unknown whether angiotensin II receptor blockade is better than beta-blockade in preventing new-onset AF.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.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.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.