Abstract 2756: Reduced Incidence of New Onset Atrial Fibrillation with Angiotensin II Receptor Blockade: The VALUE-Trial
Background: In VALUE the impact of antihypertensive treatment with valsartan and amlodipine on cardiovascular morbidity and mortality was neutral despite lower BP on amlodipine throughout. Since atrial fibrillation (AF) increases the cardiovascular risk of hypertensive patients, a secondary pre-specified objective was to compare the effects of both treatment strategies on new onset AF, i.e. the incidence of either persistent or at least one occurence of AF.
Methods: 15,245 hypertensive patients at high cardiovascular risk were treated either with valsartan (80–160 mg/d) or amlodipine (5–10 mg/d) combined with additional antihypertensive agents (diuretics, beta-blockers and others). ECG recording were obtained every year, and centrally analysed for ECG-LVH and new onset of AF.
Results: At baseline AF was diagnosed in 2.6% of the valsartan (n=7649) and in 2.6% of the amlodipine treated patients (n=7596). During antihypertensive treatment the incidence of at least one documented occurrence of new onset AF was 3.67% in the valsartan and 4.34% in the amlodipine treated patients (odds ratio 0.84 [95% CIs: 0.707, 0.995], p=0.044). The corresponding odds ratio for the incidence of AF in year 1 was 0.690 (p=0.035), in year 2 0.694 (p=0.0108); in year 3 0.708 (p=0.011) and in year 4 0.832 (p=0.120). The incidence of persistent AF was 1.35% in the valsartan and 1.97% in the amlodipine treated group (odds ratio 0.681 [95% CIs: 0.522, 0.889], p=0.005). Taking potential confounding factor as covariates into account (age, history of coronary artery disease, left ventricular hypertrophy), the incidence of AF remained significant, both for at least one AF (odds ratio 0.840 [95% CIs: 0.708 0.998], p=0.047 and for persistent AF (odds ratio 0.681 [95% CIs: 0.521, 0.889], p=0.005).
Conclusions: Valsartan based antihypertensive treatment was superior in preventing new onset AF in hypertensive patients than amlodipine based therapy. Valsartan prevented new onset AF despite less lowering of BP. Thus, angiotensin II receptor blockade emerged as a compelling treatment for hypertensive patients at risk of atrial fibrillation.