Risk for incident atrial fibrillation in patients who receive antihypertensive drugs: a nested case-control study.
BACKGROUND
Different antihypertensive drug classes may alter risk for atrial fibrillation. Some studies suggest that drugs that interfere with the renin-angiotensin system may be favorable because of their effect on atrial remodeling.


OBJECTIVE
To assess and compare the relative risk for incident atrial fibrillation among hypertensive patients who receive antihypertensive drugs from different classes.


METHODS
Nested case-control analysis.


METHODS
The United Kingdom-based General Practice Research Database, a well-validated primary care database comprising approximately 5 million patient records.


METHODS
4661 patients with atrial fibrillation and 18,642 matched control participants from a population of 682,993 patients treated for hypertension.


METHODS
A comparison of the risk for atrial fibrillation among hypertensive users of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), or beta-blockers with the reference group of users of calcium-channel blockers. Patients with clinical risk factors for atrial fibrillation were excluded.


RESULTS
Current exclusive long-term therapy with ACE inhibitors (odds ratio [OR], 0.75 [95% CI, 0.65 to 0.87]), ARBs (OR, 0.71 [CI, 0.57 to 0.89]), or beta-blockers (OR, 0.78 [CI, 0.67 to 0.92]) was associated with a lower risk for atrial fibrillation than current exclusive therapy with calcium-channel blockers.


CONCLUSIONS
Blood pressure changes during treatment courses could not be evaluated, and risk for bias by indication cannot be fully excluded in an observational study.


CONCLUSIONS
In hypertensive patients, long-term receipt of ACE inhibitors, ARBs, or beta-blockers reduces the risk for atrial fibrillation compared with receipt of calcium-channel blockers.


BACKGROUND
None.
Schaer
Beat A
BA
University Hospital, Basel, Switzerland.
Schneider
Cornelia
C
Jick
Susan S
SS
Conen
David
D
Osswald
Stefan
S
Meier
Christoph R
CR
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D055815:Young Adult
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers