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CLINICAL RESEARCH: HYPERTENSION

Angiotensin-converting enzyme inhibition in hypertensive patients is associated with a reduction in the occurrence of atrial fibrillation

Philippe L. L'Allier, MD^*, Anique Ducharme, MD^*, Pierre-Frédéric Keller, MD^*, Holly Yu, MSPH, Marie-Claude Guertin, PhD^* and Jean-Claude Tardif, MD, FACC^*,*

^* Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
Institute for Effectiveness Research, Bridgewater, New Jersey, USA

Manuscript received January 8, 2004; revised manuscript received March 17, 2004, accepted March 22, 2004.

^* Reprint requests and correspondence: Dr. Jean-Claude Tardif, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, Canada H1T 1C8.
jean-claude.tardif{at}icm-mhi.org

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 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.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ACEI = angiotensin-converting enzyme inhibitor/inhibition   AF = atrial fibrillation   CCB = calcium-channel blocker   CHD = coronary heart disease   CHF = congestive heart failure   CI = confidence interval   LA = left atrial   LV = left ventricular   MI = myocardial infarction

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