Comparison of rate and rhythm control in hypertension patients with atrial fibrillation.
BACKGROUND
Atrial fibrillation (AF) is a very common cardiac arrhythmia, and is associated with an increased mortality in patients with hypertension. Whether the best therapeutic approach for these patients is to restore sinus rhythm (SR) or to adequately control the ventricular rate is still controversial. The aim of this study is to compare both strategies in patients with hypertension.


RESULTS
Two hundred and twenty-one patients with hypertension and AF of duration >48 h were randomly assigned to either the rhythm (n=155) or rate (n=66) control group. Exercise capacity was improved in the rhythm control group in the 1st year of the study (p<0.0001). There were no statistically significant differences in the embolic event rate and the total mortality between the 2 groups at the end of the study (p=NS).


CONCLUSIONS
Although restoring and maintaining SR had a beneficial effect on exercise capacity in patients with hypertension and AF, no significant difference was found in terms of the total mortality and the embolic event rates. Thus, rate control is an acceptable primary strategy in patients with AF and hypertension.
Yildiz
Ahmet
A
Department of Cardiology, Gazi Hospital, Izmir, Turkey. drayildiz@yahoo.com
Yigit
Zerrin
Z
Okcun
Baris
B
Baskurt
Murat
M
Ortak
Kadriye
K
Kaya
Aysem
A
Kucukoglu
Serdar
S
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D014700:Verapamil / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D002316:Cardiotonic Agents; D004077:Digoxin; D014700:Verapamil; D008790:Metoprolol; D019808:Losartan