Document Detail

Blood pressure and other determinants of new-onset atrial fibrillation in patients at high cardiovascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease studies.
MedLine Citation:
PMID:  22495138     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Evidence on new-onset atrial fibrillation in high-risk vascular patients without heart failure is limited. New-onset atrial fibrillation was a prespecified secondary objective of the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET)/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) studies.
METHODS: We studied 30 424 ONTARGET/TRANSCEND patients (mean age ± SD, 66.4 ± 7.0) with vascular disease or complicated diabetes who were in sinus rhythm at entry. A copy of ECG was sent to central office every time new atrial fibrillation was detected by investigators.
RESULTS: During a median follow-up period of 4.7 years, new atrial fibrillation occurred in 2092 patients (15.1 per 1000  patient-years). Risk of atrial fibrillation increased with age, SBP and pulse pressure, left ventricular hypertrophy, BMI, serum creatinine and history of hypertension, coronary artery disease and cerebrovascular disease (all P < 0.01). After adjustment for BMI and other variables, atrial fibrillation risk increased with hip circumference. History of hypertension was associated with a 34% higher risk of new atrial fibrillation. New atrial fibrillation portended an increased risk of congestive heart failure [hazard ratio 2.89, 95% confidence interval (CI) 2.45-3.40, P < 0.01] and cardiovascular death (hazard ratio 1.22, 95% CI 1.05-1.41, P < 0.01). Risk of stroke was unaffected (hazard ratio 1.14, 95% CI 0.93-1.40), whereas that of myocardial infarction was reduced (hazard ratio 0.64, 95% CI 0.50-0.82). Patients with new atrial fibrillation were more likely to receive vitamin K antagonists (P < 0.01), statins (P < 0.05) and β-blockers (P < 0.01) than those in sinus rhythm.
CONCLUSION: New atrial fibrillation is common in high-risk vascular patients and is associated with several risk factors including history of hypertension. Hip circumference was the strongest anthropometric predictor. Despite extensive use of modern therapies, new atrial fibrillation carries a high risk of congestive heart failure and death over a relatively short term.
Paolo Verdecchia; Gilles Dagenais; Jeff Healey; Peggy Gao; Antonio L Dans; Irina Chazova; Azan S Binbrek; Gianluca Iacobellis; Rafael Ferreira; Nicolaas Holwerda; Nicholas Karatzas; Matyas Keltai; Giuseppe Mancia; Peter Sleight; Koon Teo; Salim Yusuf;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hypertension     Volume:  30     ISSN:  1473-5598     ISO Abbreviation:  J. Hypertens.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-12     Completed Date:  2012-08-13     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  1004-14     Citation Subset:  IM    
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MeSH Terms
Angiotensin II Type 1 Receptor Blockers / therapeutic use
Atrial Fibrillation / diagnosis*
Benzimidazoles / pharmacology*
Benzoates / pharmacology*
Body Mass Index
Cardiovascular Diseases / complications,  diagnosis*
Diabetes Complications / diagnosis
Double-Blind Method
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Hypertrophy, Left Ventricular / pathology
Middle Aged
Ramipril / pharmacology*
Risk Factors
Stroke / diagnosis
Vitamin K / antagonists & inhibitors
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Benzimidazoles; 0/Benzoates; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Placebos; 12001-79-5/Vitamin K; L35JN3I7SJ/Ramipril; U5SYW473RQ/telmisartan
Comment In:
J Hypertens. 2012 May;30(5):887-9   [PMID:  22495133 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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