title: Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Glostrup University Hospital, Glostrup, Denmark. kristian@wachtell.net
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.forename: Mika
authors.initials: M
authors.lastname: Lehto
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
authors.forename: Michael H
authors.initials: MH
authors.lastname: Olsen
authors.forename: Björn
authors.initials: B
authors.lastname: Hornestam
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
authors.forename: Stevo
authors.initials: S
authors.lastname: Julius
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lindholm
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D002423:Cause of Death; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy* / Q000401:mortality; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D001262:Atenolol; D019808:Losartan