title: Randomized trial of angiotensin II-receptor blocker vs. dihydropiridine calcium channel blocker in the treatment of paroxysmal atrial fibrillation with hypertension (J-RHYTHM II study).
abstract: OBJECTIVE
  Atrial fibrillation (AF) is a common arrhythmia frequently associated with hypertension. This study was designed to test the hypothesis that lowering blood pressure by angiotensin II-receptor blockers (ARB) has more beneficial effects than by conventional calcium channel blockers (CCB) on the frequency of paroxysmal AF with hypertension.
  
  
  RESULTS
  The Japanese Rhythm Management Trial II for Atrial Fibrillation (J-RHYTHM II study) is an open-label randomized comparison between an ARB (candesartan) and a CCB (amlodipine) in the treatment of paroxysmal AF associated with hypertension. Using daily transtelephonic monitoring, we examined asymptomatic and symptomatic paroxysmal AF episodes during a maximum 1 year treatment. The primary endpoint was the difference in AF frequency between the pre-treatment period and the final month of the follow-up. The secondary endpoints included cardiovascular events, development of persistent AF, left atrial dimension, and quality-of-life (QOL). The study enrolled 318 patients (66 years, male/female 219/99, 158 in the ARB group and 160 in the CCB group) treated at 48 sites throughout Japan. At baseline, the frequency of AF episodes (days/month) was 3.8 ± 5.0 in the ARB group vs. 4.8 ± 6.3 in the CCB group (not significant). During the follow-up, blood pressure was significantly lower in the CCB group than in the ARB group (P < 0.001). The AF frequency decreased similarly in both groups, and there was no significant difference in the primary endpoint between the two groups. There were no significant differences between the two groups in the development of persistent AF, changes in left atrial dimension, occurrence of cardiovascular events, or changes in QOL.
  
  
  CONCLUSIONS
  In patients with paroxysmal AF and hypertension, treatment of hypertension by candesartan did not have an advantage over amlodipine in the reduction in the frequency of paroxysmal AF (umin CTR C000000427).
authors.affiliation: J-RHYTHM II Clinical Trial Center, The Cardiovascular Institute, Tokyo, Japan. yamt-tky@umin.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
authors.forename: Itsuo
authors.initials: I
authors.lastname: Kodama
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Atarashi
authors.forename: Tohru
authors.initials: T
authors.lastname: Ohe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohtsu
authors.forename: Takao
authors.initials: T
authors.lastname: Kato
authors.forename: Shiro
authors.initials: S
authors.lastname: Kamakura
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kumagai
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kurachi
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Koretsune
authors.forename: Tetsunori
authors.initials: T
authors.lastname: Saikawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sakurai
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sato
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
authors.forename: Haruaki
authors.initials: H
authors.lastname: Nakaya
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirai
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Fukatani
authors.forename: Hideo
authors.initials: H
authors.lastname: Mitamura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Eiichi
authors.initials: E
authors.lastname: Watanabe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000494:pharmacology / Q000627:therapeutic use*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D001562:Benzimidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D007564:Japan; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D013777:Tetrazoles / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D002121:Calcium Channel Blockers; D013777:Tetrazoles; D017311:Amlodipine; C081643:candesartan