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Published in Journal Watch Cardiology
February 3, 2010
Does the Choice of Antihypertensive Agent Affect
Risk for AFib?
In a case-control study, ACE inhibitors, ARBs, and beta-blockers were associated
with a reduction in incident AF compared with calcium-channel blockers.
Summary and Comment by Joel M. Gore, MD
Copyright © 2010. Massachusetts Medical Society. All rights reserved.
Covering
• Schaer BA et al. Risk for incident atrial fibrillation in patients who
receive antihypertensive drugs: A nested case–control study. Ann
Intern Med 2010 Jan 19; 152:78.
Copyright © 2010. Massachusetts Medical Society. All rights reserved.
Background
• Hypertension is a known risk factor for atrial fibrillation.
• To assess and compare the relative risk for incident AF among
patients taking different classes of antihypertensive drugs,
investigators used a British general practice database to conduct a
nested case-control analysis.
• All participants had hypertension diagnoses and had received one
or more prescriptions for an ACE inhibitor, angiotensin-receptor
blocker, beta-blocker, calcium-channel blocker, diuretic, or any
combination of these drugs.
Copyright © 2010. Massachusetts Medical Society. All rights reserved.
The Research
• Of a total of 682,993 antihypertensive drug recipients, 4661 were
diagnosed with AF and met inclusion criteria for the analysis.
• Almost two thirds of the case patients were 70 or older at first AF
diagnosis.
• The investigators randomly identified 18,642 age- and sex-matched
participants without AF from the study population as a control group.
• Obese patients had a higher risk for AF than nonobese patients,
whereas current smokers had a lower risk for AF than nonsmokers.
Copyright © 2010. Massachusetts Medical Society. All rights reserved.
The Research
• The reference group consisted of patients receiving calcium-channel
blockers.
• Compared with the reference group, long-term (≥12 prescriptions)
ACE inhibitor recipients had a significant 25% reduction — and longterm ARB recipients had a significant 29% reduction — in risk for
incident AF.
• Patients who had received beta-blockers for at least 1 year had a
significant 22% reduction in risk for AF.
Copyright © 2010. Massachusetts Medical Society. All rights reserved.
Comment
• In patients with hypertension, different classes of drugs can have
different effects on risk for future AF.
• Clinicians should consider this possibility when prescribing drugs for
hypertension.
• In particular, avoiding calcium-channel blockers as front-line therapy
in elders might reduce their risk for AF.
Copyright © 2010. Massachusetts Medical Society. All rights reserved.
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