Effect of valsartan and ramipril on atrial fibrillation recurrence and P-wave dispersion in hypertensive patients with recurrent symptomatic lone atrial fibrillation.
BACKGROUND
This study compared the effect of antihypertensive treatment with valsartan or ramipril on atrial fibrillation (AF) recurrence, on P-wave dispersion, (PWD) and on serum procollagen type I carboxy terminal peptide (PIP).


METHODS
A total of 369 mild hypertensive (systolic blood pressure (SBP) >140 and/or 90 < diastolic blood pressure (DBP) < 110 mm Hg) outpatients in sinus rhythm but with at least two episodes of AF in the previous 6 months were randomized to valsartan (n = 122), ramipril (n = 124), or amlodipine (n = 123) for 1 year. Clinic blood pressure (BP) and a 24-h electrocardiogram (ECG) were evaluated monthly. Patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible. PWD and serum PIP levels were evaluated before and after each treatment period.


RESULTS
SBP and DBP were significantly reduced by the three treatments (P < 0.001). A total of 46 (47.4%) patients treated with amlodipine had a recurrence of AF as did 26 (27.9%) patients treated with ramipril (P < 0.01 vs. amlodipine) and 16 (16.1%) patients treated with valsartan (P < 0.01 vs. amlodipine and P < 0.05 vs. ramipril). The Kaplan-Meyer analysis showed a significant reduction of AF episodes in the valsartan group (P = 0.005 log-rank test) as well as in the ramipril group (P = 0.021), even if at a lesser degree. PWD values were significantly reduced by ramipril (-4.2 ms, P < 0.05) and even more by valsartan (-11.2 ms, P < 0.01), the difference being significant (P < 0.01). Serum PIP levels were reduced by ramipril (-49.7 microg, P < 0.001) and valsartan (-49.3 microg, P < 0.001).


CONCLUSIONS
Despite similar BP lowering, valsartan and ramipril were more effective than amlodipine in preventing new episodes of AF, but the effect of valsartan was greater than that of ramipril. This could be related to the greater PWD reduction observed with valsartan.
Department of Internal Medicine and Therapeutics, Centro per l'Ipertensione e la Fisiopatologia Cardiovascolare, University of Pavia, Pavia, Italy. r.fogari@unipv.it
Roberto
R
Fogari
Giuseppe
G
Derosa
Ilaria
I
Ferrari
Luca
L
Corradi
Annalisa
A
Zoppi
Pierangelo
P
Lazzari
Tara
T
Santoro
Paola
P
Preti
Amedeo
A
Mugellini
D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D017257:Ramipril / Q000627:therapeutic use*; D012008:Recurrence; D013777:Tetrazoles / Q000627:therapeutic use*; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
D000959:Antihypertensive Agents; D010446:Peptide Fragments; D011347:Procollagen; D013777:Tetrazoles; C042813:procollagen type I carboxy terminal peptide; D017311:Amlodipine; D000068756:Valsartan; D014633:Valine; D017257:Ramipril