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 language | English (US) |
|---|---|
| Article number | e005463 |
| Journal | Circulation: Arrhythmia and Electrophysiology |
| Volume | 10 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2017 |
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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 journal › Article
}
TY - JOUR
T1 - Pharmacologic Prevention of Incident Atrial Fibrillation
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.
PY - 2017/12/1
Y1 - 2017/12/1
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.
KW - antihypertensive agents
KW - atrial fibrillation
KW - atrial flutter
KW - primary prevention
KW - renin-angiotensin system
UR - http://www.scopus.com/inward/record.url?scp=85038403017&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85038403017&partnerID=8YFLogxK
U2 - 10.1161/CIRCEP.117.005463
DO - 10.1161/CIRCEP.117.005463
M3 - Article
C2 - 29212812
AN - SCOPUS:85038403017
VL - 10
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
SN - 1941-3149
IS - 12
M1 - e005463
ER -