Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2006 Dec 5;28(6):298–302. doi: 10.1002/clc.4960280609

The comparative effects of telmisartan and ramipril on P‐wave dispersion in hypertensive patients: A randomized clinical study

Turgay Celik 1,✉, Atila Iyisoy 1, Hurkan Kursaklioglu 1, M Ilker Yilmaz 2, Sedat Kose 1, Selim Kilic 3, Basri Amasyali 1, Sait Demirkol 1, Ersoy Isik 1
PMCID: PMC6653911  PMID: 16028466

Abstract

Background: Prolongation of P‐wave times and increase of P‐wave dispersion (PWD) were shown to be independent predictors of atrial fibrillation (AF). Angiotensin II receptor blockers (AARBs) and angiotensin‐converting enzyme inhibitors (ACEIs) have beneficial effects on atrial conduction times. However, there are not enough data about the comparative effects of those drugs onPWD.

Hypothesis: We aimed to compare the effects of telmisartan and ramipril on PWD after 6‐month treatment in hypertensive patients.

Methods: In all, 100 newly diagnosed hypertensive patients were enrolled in the study and were randomly assigned to two groups. Group 1 and Group 2 each consisted of 50 patients, taking daily doses of 80 mg telmisartan and 10 mg ramipril, respectively. Twelve‐lead surface electrocardiograms (ECG) were recorded from all patients before and after 6‐month drug therapy. The P‐wave duration (Pdur) measurements were calculated from the 12‐lead surface ECG.

Results: When pretreatment PWD and P maximum values were compared with post‐treatment values, a statistically significant decrease was found in both groups after 6 months (Group 1 and 2; p < 0.001 for PWD and Pmaximum). P‐wave dispersion and Pmaximum values after treatment in Group 1 were statistically significantly lower than those in Group 2 after the 6‐month treatment period (p = 0.01 for PWD; p = 0.008 for Pmaximum).

Conclusions: Telmisartan has a much greater lowering effect on PWD and Pmaximum values than ramipril. This finding may be important in the prevention of AF in hypertensive patients.

Keywords: P‐wave dispersion, telmisartan, ramipril, hypertension

Full Text

The Full Text of this article is available as a PDF (40.0 KB).

References

  • 1. Dilaveris PE, Gialafos JE: P‐wave dispersion: A novel predictor of paroxysmal atrial fibrillation. Ann Noninvas Electrocardiol 2001; 6: 159–165 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Dilaveris PE, Gialafos EJ, Chrissos D, Andrikopoulos GK, Richter DJ, Lazaki E, Gialafos JE: Detection of hypertensive patients at risk for paroxysmal atrial fibrillation during sinus rhythm by computer‐assisted P wave analysis. J Hypertens 1999; 17: 1463–1470 [DOI] [PubMed] [Google Scholar]
  • 3. Murray CJ, Lopez AD: Evidence‐based health policy‐Lessons from the Global Burden of Disease Study. Science 1996; 274: 740–743 [DOI] [PubMed] [Google Scholar]
  • 4. Prystowsky EN, Woodrow Benson D Jr, Fuster V, Hart RG, Kay GN, Myerburg RJ, Naccarelli GV, Wyse DG: Management of patients with atrial fibrillation: A statement for healthcare professionals from the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation 1996; 93: 1262–1277 [DOI] [PubMed] [Google Scholar]
  • 5. Goette A, Honeycutt C, Langberg JJ: Electrical remodeling in atrial fibrillation. Time course and mechanisms. Circulation 1996; 94: 2968–2974 [DOI] [PubMed] [Google Scholar]
  • 6. Nakashima H, Kumagai K, Urata H, Gondo N, Ideishi M, Arakawa K: Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Circulation 2000; 101: 2612–2617 [DOI] [PubMed] [Google Scholar]
  • 7. Tukek T, Akkaya V, Atilgan D, Demirel E, Ozcan M, Guven O, Korkut F: Effect of left atrial size and function on P‐wave dispersion: A study in patients with paroxysmal atrial fibrillation. Clin Cardiol 2001; 24: 676–680 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Pedersen OD, Bagger H, Kober L, Torp‐Pedersen C: Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 1999; 100: 376–380 [DOI] [PubMed] [Google Scholar]
  • 9. Himmelmann A, Kjeldsen SE, Hedner T: Recent hypertension guidelines: JNC‐7 and 2003 ESH/ESC. Blood Press 2003; 12: 196–197 [DOI] [PubMed] [Google Scholar]
  • 10. Lipsy RJ: The National Cholesterol Education Program Adult Treatment Panel III guidelines. J Manag Care Pharm 2003; 9 (1 suppl): 2–5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Dilaveris P, Batchvarov V, Gialafos J, Malik M: Comparison of different methods for manual P‐wave duration measurement in 12‐lead electrocardiograms. Pacing Clin Electrophysiol 1999; 22: 1532–1538 [DOI] [PubMed] [Google Scholar]
  • 12. Pfeffer MA, Braunwald E, Moyé LA, Basta L, Brown EJ Jr, Cuddy TE, Davis BR, Geltman EM, Goldman S, Flaker GC, Klein M, Lamas GA, Packer M, Rouleau J, Rouleau JL, Rutherford JD, Wertheimer JH, Hawkins CM, on behalf of the SAVE Investigators : Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the Survival and Ventricular Enlargement trial. N Engl J Med 1992; 327: 669–677 [DOI] [PubMed] [Google Scholar]
  • 13. Harada K, Komuro I, Hayashi D, Sugaya T, Murakami K, Yazaki Y: Angiotensin II type 1a receptor is involved in the occurrence of reperfusion arrhythmias. Circulation 1998; 97: 315–317 [DOI] [PubMed] [Google Scholar]
  • 14. Fortuno MA, Ravassa S, Etayo JC, Diez J: Overexpression of Bax protein and enhanced apoptosis in the left ventricle of spontaneously hypertensive rats: Effects of AT1 blockade with losartan. Hypertension 1998; 32: 280–286 [DOI] [PubMed] [Google Scholar]
  • 15. Lopez B, Querejeta R, Varo N, Gonzalez A, Larman M, Martinez Ubago JL, Diez J: Usefulness of serum carboxyterminal propeptide of procollagen type I in assessment of cardioreparative ability of antihypertensive treatment in hypertensive patients. Circulation 2001; 104: 286–291 [DOI] [PubMed] [Google Scholar]
  • 16. Madrid AH, Bueno MG, Rebollo JM, Marin I, Pena G, Bernal E, Rodriguez A, Cano L, Cano JM, Cabeza P, Moro C: Use of irbesartan to maintain sinus rhythm in patients with long‐lasting persistent atrial fibrillation: A prospective and randomized study. Circulation 2002; 106: 331–336 [DOI] [PubMed] [Google Scholar]
  • 17. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G: Effects of anangiotensin‐converting‐enzyme inhibitor, ramipril, on cardiovascular events in high‐risk patients. HOPE Study Investigators. N Engl J Med 2000; 342: 145–153 [DOI] [PubMed] [Google Scholar]
  • 18. Mitchell AR, Spurrell PA, Sulke N: Circadian variation of arrhythmia onset patterns in patients with persistent atrial fibrillation. Am Heart J 2003; 146: 902–907 [DOI] [PubMed] [Google Scholar]
  • 19. Ciaroni S, Cuenoud L, Bloch A: Clinical study to investigate the predictive parameters for the onset of atrial fibrillation in patients with essential hypertension. Am Heart J 2000; 139: 814–819 [DOI] [PubMed] [Google Scholar]
  • 20. McClellan KJ, Markham A: Telmisartan. Drugs 1998; 56: 1039–1044 [DOI] [PubMed] [Google Scholar]
  • 21. Teo K, Yusuf S, Anderson C, Mookadam F, Ramos B, Hilbrich L, Pogue J, Schumacher H, for the ONTARGET/TRANSCEND Investigators : Rationale, design, and baseline characteristics of 2 large, simple, randomized trials evaluating telmisartan, ramipril, and their combination in high‐risk patients: The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND) trials. Am Heart J 2004; 148: 52–61 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES