Table 2.
Studies of the effectiveness of ARBs in the prevention of AF (new onset and recurrent)
| Study | Design/follow-up | N | Interventions | AF-related endpoints |
|---|---|---|---|---|
| New-onset AF | ||||
| SCOPE71 | MC, R, DB, hypertension (elderly) | 4964 | Candesartan (Can) | Incidence of nonfatal stroke |
| PL | Can 7.4 vs PL 10.3/1000 patient-years (risk reduction 27.8%, P = 0.04) | |||
| Mean, 3.7 years | ||||
| LIFE28 | MC, R, DB, hypertension/LVH | 8851a | Losartan (Los) | Incidence of AF |
| Mean, 4.8 years | Atenolol (At) | Los 6.8 vs At 10.1/1000 patient-years (RR 0.67, P < 0.001) | ||
| Maintenance of sinus rhythm | ||||
| Los 1809 ±225 days vs At 1709 ± 254 days (P =0.057) | ||||
| VALUE27,30 | Retrospective analysis of MC, R, DB study (hypertension) | 15,245 | Valsartan (Val) | Incidence of new-onset AF |
| Amlodipine (Aml) | Val 3.7% vs Aml 4.3% (P =0.044) | |||
| Rate of persistent AF | ||||
| Mean, 4.2 years | Val 1.4% vs Aml 2.0% (P =0.005) | |||
| ONTARGET72 | MC, R, DB, patients at high risk of vascular events | 25,620 | Telmisartan (Tel) | Incidence of new-onset AF |
| Ramipril (Ram) | Tel 6.7% vs Ram 6.9% vs Ram ± Tel 6.5% (all P =NS between treatments; Tel vs Ram RR 0.97) | |||
| Median, 56 months | Ram ± Tel combination therapy | |||
| Recurrent AF | ||||
| Fogari et al73 | R, open-label, hypertension/type 2 diabetes/AF | 296 | Valsartan (Val) | Incidence of recurrent AF |
| Atenolol (At) | Val ± Aml 20.3% vs At + Aml 34.1% (P < 0.01) | |||
| 1 year | (± Amlodipine [Aml]) | |||
| Fogari et al74 | R, DB, hypertension/AF | 369 | Valsartan (Val) | Incidence of recurrent AF |
| 1 year | Ramipril (Ram) | Val 16.1% vs Ram 27.9% vs Aml 47.4% (P < 0.01 Val vs Aml and P < 0.05 Val vs Ram) | ||
| Amlodipine (Aml) | ||||
| GISSI-AF75 | MC, R, DB, PL, AF | 1442 | Valsartan (V) | Incidence of recurrent AF |
| Median, 1 year | PL | Val 51.4% vs PL 52.1% (HR 0.99), but trend favored Val in patients with CHF and/or LV dysfunction (HR 0.81) | ||
| CAPRAF76,77 | R, DB, PL, AF | 171 | Candesartan (Can) | Incidence of recurrent AF |
| 6 months | PL | Can 71% vs PL 65% (P =0.20) in patients with persistent AF who underwent ECV | ||
a
Note: No AF at baseline.
Abbreviations: AF, atrial fibrillation; ARB, angiotensin II receptor blocker; CHF, congestive heart failure; DB, double-blind; ECV, electrical cardioversion; HR, hazard ratio; LVH, left ventricular hypertrophy; MC, multicenter; PL, placebo; R, randomized; RR, relative risk. Trial acronyms are expanded in the text.