Reduced incidence of new-onset atrial fibrillation with angiotensin II receptor blockade: the VALUE trial

• Published in: Journal of hypertension Vol. 26; no. 3; pp. 403 - 411
• Main Authors: Schmieder, Roland E, Kjeldsen, Sverre E, Julius, Stevo, McInnes, Gordon T, Zanchetti, Alberto, Hua, Tsushung A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-03-2008; Lippincott Williams & Wilkins
• Subjects: Aged; Amlodipine - administration & dosage; Angiotensin II Type 1 Receptor Blockers - administration & dosage; Antihypertensive Agents - administration & dosage; Arterial hypertension. Arterial hypotension; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - prevention & control; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Drug Therapy, Combination; Female; Humans; Hypertension - drug therapy; Incidence; Male; Medical sciences; Middle Aged; Tetrazoles - administration & dosage; Treatment Outcome; Valine - administration & dosage; Valine - analogs & derivatives; Valsartan; Hypertension; Arrhythmia; Atrial fibrillation; Peptide hormone; Cardiovascular disease; angiotensin receptor blocker; Excitability disorder; Incidence; Prevention; arterial hypertension; Octapeptide; Heart disease; Angiotensin II
• ISSN: 0263-6352; 1473-5598
• DOI: 10.1097/HJH.0b013e3282f35c67

BACKGROUNDAtrial fibrillation (AF) is the most common arrhythmia and increases cardiovascular risk in hypertensive patients. Therefore, in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) a prespecified objective was to compare the effects of valsartan and amlodipine on new-onset AF.
METHODSA total of 15 245 hypertensive patients at high cardiovascular risk received valsartan 80–160 mg/day or amlodipine 5–10 mg/day combined with additional antihypertensive agents. Electrocardiograms were obtained every year and analyzed centrally for evidence of left ventricular hypertrophy and new-onset AF.
RESULTSAt baseline, AF was diagnosed in 2.6% of 7649 valsartan recipients and 2.6% of 7596 amlodipine recipients. During antihypertensive treatment the incidence of at least one documented occurrence of new-onset AF was 3.67% with valsartan and 4.34% with amlodipine {unadjusted hazard ratio 0.843, [95% confidence interval (CI)0.713, 0.997], P = 0.0455}. The incidence of persistent AF was 1.35% with valsartan and 1.97% with amlodipine [unadjusted hazard ratio 0.683 (95% CI0.525, 0.889), P = 0.0046].
CONCLUSIONSValsartan-based treatment reduced the development of new-onset AF, particularly sustained AF in hypertensive patients, compared with amlodipine-based therapy. These findings suggest that angiotensin II receptor blockers may result in greater benefits than calcium antagonists in hypertensive patients at risk of new-onset AF.