title: Effect of telmisartan and ramipril on atrial fibrillation recurrence and severity in hypertensive patients with metabolic syndrome and recurrent symptomatic paroxysmal and persistent atrial fibrillation.
abstract: This study evaluated the effect of telmisartan, ramipril, and amlodipine on atrial fibrillation (AF) recurrence and severity in hypertensive patients with metabolic syndrome. A total of 391 hypertensive outpatients with metabolic syndrome, in sinus rhythm but with at least 2 episodes of AF in the previous 6 months were randomized to telmisartan, ramipril, or amlodipine for 1 year. At the first AF, ventricular rate (VR) and plasma cardiac troponin I (TnI) were evaluated. P-wave dispersion (PWD) and procollagen type I carboxy-terminal peptide (PIP) were evaluated before and after 12 months of treatment. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were similarly and significantly reduced by all treatments (P < .001). In all, 49% of patients treated with amlodipine had a recurrence of AF as did 25.5% of patients with ramipril and 12.9% of patients with telmisartan (P < .01 vs amlodipine and P < .05 vs ramipril). Ventricular rate and TnI at the first AF recurrence were significantly lower with telmisartan and ramipril than with amlodipine. P-wave dispersion was reduced by ramipril (-5.1 ms, P < .05) and even more by telmisartan (-11 ms, P < .01). Telmisartan and ramipril induced a similar PIP reduction (-52.8 and -49.8 µg/L, respectively, P < .01). These findings suggested that in these patients telmisartan was more effective than ramipril in reducing AF recurrence and severity as well as in improving PWD, despite a similar BP reduction and a similar improvement in cardiac fibrosis. This could be related to a specific effect of telmisartan on atrial electric remodeling.
authors.affiliation: Department of Internal Medicine and Therapeutics, Centro per l'ipertensione e la fisiopatologia cardiovascolare, University of Pavia, Pavia, Italy. r.fogari@unipv.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Fogari
authors.forename: Amedeo
authors.initials: A
authors.lastname: Mugellini
authors.forename: Annalisa
authors.initials: A
authors.lastname: Zoppi
authors.forename: Paola
authors.initials: P
authors.lastname: Preti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Destro
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Lazzari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Derosa
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D001562:Benzimidazoles / Q000627:therapeutic use*; D001565:Benzoates / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D017257:Ramipril / Q000627:therapeutic use*; D055502:Secondary Prevention; D012720:Severity of Illness Index; D000077333:Telmisartan; D016896:Treatment Outcome
chemical_list: D001562:Benzimidazoles; D001565:Benzoates; D017257:Ramipril; D000077333:Telmisartan