title: Effect of telmisartan on paroxysmal atrial fibrillation recurrence in hypertensive patients with normal or increased left atrial size.
abstract: BACKGROUND
  Hypertension is the most prevalent and potentially modifiable risk factor for atrial fibrillation (AF). In a previous secondary prevention study, the authors observed that the angiotensin II receptor blocker telmisartan was more effective than the calcium channel blocker amlodipine in preventing AF relapse in hypertensive patients with normal atrial size.
  
  
  OBJECTIVE
  Telmisartan may be more effective than amlodipine in preventing AF recurrence in hypertensive patients with paroxysmal AF and normal or increased left atrial dimension (LAD).
  
  
  METHODS
  The authors assigned 378 mild hypertensive outpatients in sinus rhythm, but with ≥2 episodes of AF in the previous 6 months, to 1 of 2 groups. Group 1 comprised patients with LAD <40 mm in females and <45 mm in males. Group 2 comprised patients with LAD >40 mm and <45 mm in females and >45 mm and <50 mm in males. In both groups, patients were randomly treated with telmisartan or amlodipine for 1 year.
  
  
  RESULTS
  Systolic and diastolic blood pressure were similarly reduced by telmisartan and amlodipine in both groups. The AF recurrence rate was significantly lower in the telmisartan-treated patients than in the amlodipine-treated patients in both group 1 (12 vs 39, P < 0.01) and group 2 (40 vs 59, P < 0.05). Under telmisartan, the AF recurrence rate was significantly lower in group 1 than in group 2 (12.9% vs 42.1%, P < 0.05). Time to a first AF relapse was significantly longer with telmisartan than with amlodipine in both group 1 (176 ± 94 days vs 74 ± 61 days, P < 0.05) and group 2 (119 ± 65 days vs 38 ± 35 days, P < 0.05).
  
  
  CONCLUSIONS
  Telmisartan was more effective than amlodipine in preventing AF recurrences in hypertensive patients with paroxysmal AF.
authors.affiliation: Department of Internal Medicine and Therapeutics, Center for Hypertension and Cardiovascular Physiopathology, University of Pavia, Pavia, Italy. r.fogari@unipv.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Fogari
authors.forename: Annalisa
authors.initials: A
authors.lastname: Zoppi
authors.forename: Pamela
authors.initials: P
authors.lastname: Maffioli
authors.forename: Amedeo
authors.initials: A
authors.lastname: Mugellini
authors.forename: Paola
authors.initials: P
authors.lastname: Preti
authors.forename: Tiziano
authors.initials: T
authors.lastname: Perrone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Derosa
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000517:prevention & control; D001562:Benzimidazoles / Q000627:therapeutic use*; D001565:Benzoates / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006325:Heart Atria / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D000077333:Telmisartan
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001565:Benzoates; D002121:Calcium Channel Blockers; D017311:Amlodipine; D000077333:Telmisartan