Pharmacologic Prevention of Incident Atrial Fibrillation: Long-Term Results from the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

Thomas Dewland, Elsayed Z. Soliman, Jose Miguel Yamal, Barry R. Davis, Alvaro Alonso, Christine M. Albert, Lara M. Simpson, L. Julian Haywood, Gregory M. Marcus

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Although atrial fibrillation (AF) guidelines indicate that pharmacological blockade of the renin-angiotensin system may be considered for primary AF prevention in hypertensive patients, previous studies have yielded conflicting results. We sought to determine whether randomization to lisinopril reduces incident AF or atrial flutter (AFL) compared with chlorthalidone in a large clinical trial cohort with extended post-trial surveillance. Methods and Results We performed a secondary analysis of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), a randomized, double-blind, active-controlled clinical trial that enrolled hypertensive individuals ≥55 years of age with at least one other cardiovascular risk factor. Participants were randomly assigned to receive amlodipine, lisinopril, or chlorthalidone. Individuals with elevated fasting low-density lipoprotein cholesterol levels were also randomized to pravastatin versus usual care. The primary outcome was the development of either AF or AFL as diagnosed by serial study ECGs or by Medicare claims data. Among 14 837 participants without prevalent AF or AFL, 2514 developed AF/AFL during a mean 7.5±3.2 years of follow-up. Compared with chlorthalidone, randomization to either lisinopril (hazard ratio, 1.04; 95% confidence interval, 0.94-1.15; P=0.46) or amlodipine (hazard ratio, 0.93; 95% confidence interval, 0.84-1.03; P=0.16) was not associated with a significant reduction in incident AF/AFL. Conclusions Compared with chlorthalidone, treatment with lisinopril is not associated with a meaningful reduction in incident AF or AFL among older adults with a history of hypertension. Clinical Trial Registration URL: Http://www.clinicaltrials.gov. Unique identifier: NCT00000542.

Original languageEnglish (US)
Article numbere005463
JournalCirculation: Arrhythmia and Electrophysiology
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2017

Fingerprint

Atrial Fibrillation
Antihypertensive Agents
Atrial Flutter
Myocardial Infarction
Chlorthalidone
Lisinopril
Lipids
Amlodipine
Therapeutics
Random Allocation
Clinical Trials
Confidence Intervals
Pravastatin
Controlled Clinical Trials
Renin-Angiotensin System
Medicare
LDL Cholesterol
Fasting
Electrocardiography
Pharmacology

Keywords

  • antihypertensive agents
  • atrial fibrillation
  • atrial flutter
  • primary prevention
  • renin-angiotensin system

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Pharmacologic Prevention of Incident Atrial Fibrillation : Long-Term Results from the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). / Dewland, Thomas; Soliman, Elsayed Z.; Yamal, Jose Miguel; Davis, Barry R.; Alonso, Alvaro; Albert, Christine M.; Simpson, Lara M.; Haywood, L. Julian; Marcus, Gregory M.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 10, No. 12, e005463, 01.12.2017.

Research output: Contribution to journalArticle

Dewland, Thomas ; Soliman, Elsayed Z. ; Yamal, Jose Miguel ; Davis, Barry R. ; Alonso, Alvaro ; Albert, Christine M. ; Simpson, Lara M. ; Haywood, L. Julian ; Marcus, Gregory M. / Pharmacologic Prevention of Incident Atrial Fibrillation : Long-Term Results from the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). In: Circulation: Arrhythmia and Electrophysiology. 2017 ; Vol. 10, No. 12.
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abstract = "Background Although atrial fibrillation (AF) guidelines indicate that pharmacological blockade of the renin-angiotensin system may be considered for primary AF prevention in hypertensive patients, previous studies have yielded conflicting results. We sought to determine whether randomization to lisinopril reduces incident AF or atrial flutter (AFL) compared with chlorthalidone in a large clinical trial cohort with extended post-trial surveillance. Methods and Results We performed a secondary analysis of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), a randomized, double-blind, active-controlled clinical trial that enrolled hypertensive individuals ≥55 years of age with at least one other cardiovascular risk factor. Participants were randomly assigned to receive amlodipine, lisinopril, or chlorthalidone. Individuals with elevated fasting low-density lipoprotein cholesterol levels were also randomized to pravastatin versus usual care. The primary outcome was the development of either AF or AFL as diagnosed by serial study ECGs or by Medicare claims data. Among 14 837 participants without prevalent AF or AFL, 2514 developed AF/AFL during a mean 7.5±3.2 years of follow-up. Compared with chlorthalidone, randomization to either lisinopril (hazard ratio, 1.04; 95{\%} confidence interval, 0.94-1.15; P=0.46) or amlodipine (hazard ratio, 0.93; 95{\%} confidence interval, 0.84-1.03; P=0.16) was not associated with a significant reduction in incident AF/AFL. Conclusions Compared with chlorthalidone, treatment with lisinopril is not associated with a meaningful reduction in incident AF or AFL among older adults with a history of hypertension. Clinical Trial Registration URL: Http://www.clinicaltrials.gov. Unique identifier: NCT00000542.",
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T2 - Long-Term Results from the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

AU - Dewland, Thomas

AU - Soliman, Elsayed Z.

AU - Yamal, Jose Miguel

AU - Davis, Barry R.

AU - Alonso, Alvaro

AU - Albert, Christine M.

AU - Simpson, Lara M.

AU - Haywood, L. Julian

AU - Marcus, Gregory M.

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N2 - Background Although atrial fibrillation (AF) guidelines indicate that pharmacological blockade of the renin-angiotensin system may be considered for primary AF prevention in hypertensive patients, previous studies have yielded conflicting results. We sought to determine whether randomization to lisinopril reduces incident AF or atrial flutter (AFL) compared with chlorthalidone in a large clinical trial cohort with extended post-trial surveillance. Methods and Results We performed a secondary analysis of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), a randomized, double-blind, active-controlled clinical trial that enrolled hypertensive individuals ≥55 years of age with at least one other cardiovascular risk factor. Participants were randomly assigned to receive amlodipine, lisinopril, or chlorthalidone. Individuals with elevated fasting low-density lipoprotein cholesterol levels were also randomized to pravastatin versus usual care. The primary outcome was the development of either AF or AFL as diagnosed by serial study ECGs or by Medicare claims data. Among 14 837 participants without prevalent AF or AFL, 2514 developed AF/AFL during a mean 7.5±3.2 years of follow-up. Compared with chlorthalidone, randomization to either lisinopril (hazard ratio, 1.04; 95% confidence interval, 0.94-1.15; P=0.46) or amlodipine (hazard ratio, 0.93; 95% confidence interval, 0.84-1.03; P=0.16) was not associated with a significant reduction in incident AF/AFL. Conclusions Compared with chlorthalidone, treatment with lisinopril is not associated with a meaningful reduction in incident AF or AFL among older adults with a history of hypertension. Clinical Trial Registration URL: Http://www.clinicaltrials.gov. Unique identifier: NCT00000542.

AB - Background Although atrial fibrillation (AF) guidelines indicate that pharmacological blockade of the renin-angiotensin system may be considered for primary AF prevention in hypertensive patients, previous studies have yielded conflicting results. We sought to determine whether randomization to lisinopril reduces incident AF or atrial flutter (AFL) compared with chlorthalidone in a large clinical trial cohort with extended post-trial surveillance. Methods and Results We performed a secondary analysis of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), a randomized, double-blind, active-controlled clinical trial that enrolled hypertensive individuals ≥55 years of age with at least one other cardiovascular risk factor. Participants were randomly assigned to receive amlodipine, lisinopril, or chlorthalidone. Individuals with elevated fasting low-density lipoprotein cholesterol levels were also randomized to pravastatin versus usual care. The primary outcome was the development of either AF or AFL as diagnosed by serial study ECGs or by Medicare claims data. Among 14 837 participants without prevalent AF or AFL, 2514 developed AF/AFL during a mean 7.5±3.2 years of follow-up. Compared with chlorthalidone, randomization to either lisinopril (hazard ratio, 1.04; 95% confidence interval, 0.94-1.15; P=0.46) or amlodipine (hazard ratio, 0.93; 95% confidence interval, 0.84-1.03; P=0.16) was not associated with a significant reduction in incident AF/AFL. Conclusions Compared with chlorthalidone, treatment with lisinopril is not associated with a meaningful reduction in incident AF or AFL among older adults with a history of hypertension. Clinical Trial Registration URL: Http://www.clinicaltrials.gov. Unique identifier: NCT00000542.

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