Document Detail

Angiotensin-converting enzyme inhibition in hypertensive patients is associated with a reduction in the occurrence of atrial fibrillation.
MedLine Citation:
PMID:  15234426     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The objective of this study was to determine the effects of angiotensin-converting enzyme inhibition (ACEI) versus long-acting calcium-channel blockade (CCB) on atrial fibrillation (AF) in patients with hypertension. BACKGROUND: Atrial fibrillation is the most common significant cardiac arrhythmia, and angiotensin II has been implicated in its pathophysiology. METHODS: This was a retrospective, longitudinal cohort study from a database of 8 million people in the U.S. Patients age > or =18 years with hypertension were eligible if they filled a prescription for either an ACEI or a CCB between January 1995 and June 1999. The use of all other antihypertensive medications was permitted. Patient chronic disease burden was assessed using a modified Charlson index. Patients were matched on a propensity score generated from a logistic regression model. A survival analysis approach was used to compare the incidence of AF between groups. The final cohorts were evaluated until June 2002, and the average follow-up was 4.5 years. RESULTS: After cohort matching, 10,926 patients were included in the analysis and divided equally into the ACEI and CCB groups. Mean patient age was 65 years. The adjusted hazards ratio (95% confidence interval [CI]) in the ACEI versus CCB groups for the entire follow-up period was 0.85 (95% CI: 0.74 to 0.97) for new-onset AF, and the adjusted incidence ratio for AF-related hospitalizations was 0.74 (95% CI: 0.62 to 0.89). CONCLUSIONS: Angiotensin-converting enzyme inhibition was associated with a reduced incidence of AF for patients with hypertension in a usual care setting. These results need to be confirmed in a large-scale randomized clinical trial.
Philippe L L'Allier; Anique Ducharme; Pierre-Frédéric Keller; Holly Yu; Marie-Claude Guertin; Jean-Claude Tardif
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  44     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-05     Completed Date:  2004-09-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  159-64     Citation Subset:  AIM; IM    
Research Center, Montreal Heart Institute, Montreal, Quebec, Canada.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Antihypertensive Agents / therapeutic use
Atrial Fibrillation / drug therapy*
Calcium Channel Blockers / therapeutic use
Cohort Studies
Follow-Up Studies
Hypertension / drug therapy*
Longitudinal Studies
Middle Aged
Retrospective Studies
Risk Reduction Behavior*
Statistics as Topic
Treatment Outcome
United States / epidemiology
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Calcium Channel Blockers
Comment In:
J Am Coll Cardiol. 2005 Apr 5;45(7):1144; author reply 1144   [PMID:  15808777 ]

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