Diltiazem reduces levels of NT-proBNP and improves symptoms compared with metoprolol in patients with permanent atrial fibrillation

• Published in: European heart journal. Cardiovascular pharmacotherapy Vol. 10; no. 6; pp. 515 - 525
• Main Authors: Enge, Katrine, Tveit, Arnljot, Enger, Steve, Onarheim, Sophia, Pripp, Are Hugo, Rønningen, Peter Selmer, Solberg, Magnar Gangås, Byrkjeland, Rune, Andresen, Kristoffer, Halsen, Anders, Aulie, Hanne Aaserud, Steinsvik, Trude, Hall, Christian, Ulimoen, Sara Reinvik
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 04-10-2024
• Subjects: Aged; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - therapeutic use; Atrial fibrillation; Atrial Fibrillation - blood; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - physiopathology; Biomarkers - blood; Calcium Channel Blockers - therapeutic use; Calcium channels; Cardiac arrhythmia; Care and treatment; Comparative analysis; Diltiazem; Diltiazem - therapeutic use; Female; Heart beat; Heart rate; Heart Rate - drug effects; Humans; Male; Metoprolol - therapeutic use; Middle Aged; Natriuretic Peptide, Brain - blood; Natriuretic peptides; Patient compliance; Peptide Fragments - blood; Peptides; Treatment Outcome; Canada; Norway; Rhythm-related symptoms; Beta-blockers; Atrial fibrillation; Calcium channel blockers; Rate control; Natriuretic peptides
• ISSN: 2055-6837; 2055-6845; 2055-6845
• DOI: 10.1093/ehjcvp/pvae032

Abstract
Aims
Short-term treatment with calcium channel blockers lowers levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) and reduces rhythm-related symptoms compared to treatment with beta-blockers. The aim of this study was to compare the effects of metoprolol and diltiazem for rate control in patients with permanent atrial fibrillation (AF) after 6 months.
Methods and results
Men and women with permanent AF and preserved left ventricular systolic function were randomized to receive either diltiazem 360 mg or metoprolol 100 mg once daily. The primary endpoint was the level of NT-proBNP after a 6-month treatment period. Secondary endpoints included heart rate, rhythm-related symptoms and exercise capacity. A total of 93 patients (mean age 71 ± 7 years, 28 women) were randomized. After 6-months’ treatment, mean levels of NT-proBNP decreased in the diltiazem group and increased in the metoprolol group, with a significant between-group difference (409.8 pg/mL, 95% CI: 230.6–589.1, P < 0.001). Treatment with diltiazem significantly reduced rhythm-related symptoms compared to baseline, but no change was observed in the metoprolol group. Diltiazem and metoprolol had similar effects on heart rate and exercise capacity.
Conclusion
Diltiazem reduced NT-proBNP levels and improved rhythm-related symptoms. Metoprolol increased peptide levels but had no impact on symptoms despite similar heart rate reduction. Non-dihydropyridine calcium channel blockers should be considered more often for rate control in permanent AF.
Graphical Abstract
Graphical Abstract
Figure developed by the authors with venngage.com with licence to use, reproduce and distribute. AF, atrial fibrillation; EF, ejection fraction; and NT-proBNP, N-terminal pro-B-type natriuretic peptide.