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Telmisartan more effective than Carvedilol in preventing recurrent atrial fibrillation episodes in patients with hypertension and atrial fibrillation

Atrial remodelling, leading to atrial fibrillation, is mediated by the renin-angiotensin-aldosterone system.

Mild hypertensive outpatients ( systolic/diastolic blood pressure 140-159/90-99 mmHg ) in sinus rhythm who had experienced greater than or equal to 1 electrocardiogram (ECG)-documented atrial fibrillation episode in the previous six months received randomly Telmisartan ( Micardis ) 80 mg/day or Carvedilol ( Coreg, Dilatrend ) 25 mg/day.

Blood pressure and 24-hour ECG were monitored monthly for one year; patients were asked to report symptomatic atrial fibrillation episodes and to undergo an ECG as early as possible.

One hundred and thirty-two patients completed the study ( Telmisartan, n=70; Carvedilol, n=62 ).

Significantly fewer atrial fibrillation episodes were reported with Telmisartan versus Carvedilol ( 14.3% vs. 37.1%; p less than 0.003 ).

Left atrial diameter, assessed by echocardiography, was similar with Telmisartan and Carvedilol ( 3.4±2.3 cm vs. 3.6±2.4 cm ).

At study end, both regimes significantly reduced mean left ventricular mass index, but the reduction obtained with Telmisartan was significantly greater than with Carvedilol ( 117.8±10.7 vs 124.7±14.5; p less than 0.0001 ).

Mean blood pressure values were not significantly different between the groups ( Telmisartan 154/97 to 123/75 mmHg; p less than 0.001; Carvedilol 153/94 to 125/78 mmHg; p less than 0.001 ).

In conclusion, Telmisartan was significantly more effective than Carvedilol in preventing recurrent atrial fibrillation episodes in hypertensive patients with atrial fibrillation, despite a similar lowering of blood pressure. ( Xagena )

Galzerano D et al, J Renin Angiotensin Aldosterone Syst 2012;13:496-503