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. Hypothesis: 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.

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication

“…178 The abnormal atrial substrate is reversible, with studies demonstrating improved electrical and structural parameters and reduced AF burden following treatment with renin – angiotensin – aldosterone system blockers. 179–181 In patients with resistant hypertension and improved blood pressure following renal denervation, there was a global improvement in atrial conduction and reduced complex fractionated activity. Histologically, pressure overload induces hypertrophy of atrial myocytes (EHRAS Class I).…”

Risk Factors for Atrial Fibrillation in Patients With Normal Versus Dilated Left Atrium (from the Atherosclerosis Risk in Communities Study)

“…4-6 However, a sizable minority of patients with AF has normal LA. 7 The aims of this study are to investigate traditional AF risk factors in patients with and without dilated LA, and to determine whether the association of these risk factors differs by LA cavity size.…”

Effect of Telmisartan on Atrial Fibrillation Recurrences in Patients with Hypertension: A Systematic Review and Meta‐Analysis

“…Of the four included studies, three studies [19][20][21] showed a statistically significant superiority of telmisartan to other antihypertensive drugs (ramipril, amlodipine, and carvedilol), one study [22] found the similar effects of telmisartan to nifedipine, but telmisartan has more potent effects on preventing paroxysmal AF to persistent AF.…”

“…Of these, careful reading only retrieved four studies fulfilling our inclusion criteria [19][20][21][22], then they were calculated by MA ( Figure 1). …”

“…In theory, all effective antihypertensive drugs could reduce the risk of AF nearly by reversing structural cardiac damage caused by hypertension [17,18]. On the contrary, some recent studies suggested there were more advantage for telmisartan, as a kind of antihypertensive drugs of angiotensin receptor blockers (ARBs) is more effective in prevention of AF relapse or development than others in hypertensive patients with paroxysmal AF history [19][20][21][22].…”