Randomized trial of angiotensin II-receptor blocker vs. dihydropiridine calcium channel blocker in the treatment of paroxysmal atrial fibrillation with hypertension (J-RHYTHM II study).

Abstract

AIMS:

Atrial fibrillation (AF) is a common arrhythmia frequently associated with hypertension. This study was designed to test the hypothesis that lowering blood pressure by angiotensin II-receptor blockers (ARB) has more beneficial effects than by conventional calcium channel blockers (CCB) on the frequency of paroxysmal AF with hypertension.

METHODS AND RESULTS:

The Japanese Rhythm Management Trial II for Atrial Fibrillation (J-RHYTHM II study) is an open-label randomized comparison between an ARB (candesartan) and a CCB (amlodipine) in the treatment of paroxysmal AF associated with hypertension. Using daily transtelephonic monitoring, we examined asymptomatic and symptomatic paroxysmal AF episodes during a maximum 1 year treatment. The primary endpoint was the difference in AF frequency between the pre-treatment period and the final month of the follow-up. The secondary endpoints included cardiovascular events, development of persistent AF, left atrial dimension, and quality-of-life (QOL). The study enrolled 318 patients (66 years, male/female 219/99, 158 in the ARB group and 160 in the CCB group) treated at 48 sites throughout Japan. At baseline, the frequency of AF episodes (days/month) was 3.8 ± 5.0 in the ARB group vs. 4.8 ± 6.3 in the CCB group (not significant). During the follow-up, blood pressure was significantly lower in the CCB group than in the ARB group (P < 0.001). The AF frequency decreased similarly in both groups, and there was no significant difference in the primary endpoint between the two groups. There were no significant differences between the two groups in the development of persistent AF, changes in left atrial dimension, occurrence of cardiovascular events, or changes in QOL.

CONCLUSIONS:

In patients with paroxysmal AF and hypertension, treatment of hypertension by candesartan did not have an advantage over amlodipine in the reduction in the frequency of paroxysmal AF (umin CTR C000000427).

• Authors: Takeshi Yamashita, Hiroshi Inoue, Ken Okumura, Itsuo Kodama, Yoshifusa Aizawa, Hirotsugu Atarashi, Tohru Ohe, Hiroshi Ohtsu, Takao Kato, Shiro Kamakura, Koichiro Kumagai, Yoshihisa Kurachi, Yukihiro Koretsune, Tetsunori Saikawa, Masayuki Sakurai, Toshiaki Sato, Kaoru Sugi, Haruaki Nakaya, Makoto Hirai, Atsushi Hirayama, Masahiko Fukatani, Hideo Mitamura, Tsutomu Yamazaki, Eiichi Watanabe, Satoshi Ogawa, J-RHYTHM II Investigators
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 13 Issue 4 Pg. 473-9 (Apr 2011) ISSN: 1532-2092 [Electronic] England
• PMID: 21148662 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin II Type 1 Receptor Blockers
• Benzimidazoles
• Biphenyl Compounds
• Calcium Channel Blockers
• Tetrazoles
• Amlodipine
• candesartan

Topics

• Aged
• Amlodipine (pharmacology, therapeutic use)
• Angiotensin II Type 1 Receptor Blockers (pharmacology, therapeutic use)
• Atrial Fibrillation (drug therapy, epidemiology)
• Benzimidazoles (pharmacology, therapeutic use)
• Biphenyl Compounds
• Blood Pressure (drug effects)
• Calcium Channel Blockers (pharmacology, therapeutic use)
• Comorbidity
• Female
• Follow-Up Studies
• Humans
• Hypertension (drug therapy, epidemiology)
• Japan
• Male
• Middle Aged
• Prevalence
• Quality of Life
• Tetrazoles (pharmacology, therapeutic use)
• Time Factors
• Treatment Outcome